Provider Demographics
NPI:1629028220
Name:DE LUNA, CARLO M (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:M
Last Name:DE LUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N RIVER ST STE 240
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2643
Mailing Address - Country:US
Mailing Address - Phone:705-706-2620
Mailing Address - Fax:
Practice Address - Street 1:545 N RIVER ST STE 240
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2643
Practice Address - Country:US
Practice Address - Phone:705-706-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425987207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012327460001Medicaid
PA1012327460001Medicaid
G35424Medicare UPIN