Provider Demographics
NPI:1710946462
Name:DELUCA, PAMELA (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BEHARRELL ST # 80A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1739
Mailing Address - Country:US
Mailing Address - Phone:781-259-9292
Mailing Address - Fax:781-259-0747
Practice Address - Street 1:80 BEHARRELL ST # 80A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1739
Practice Address - Country:US
Practice Address - Phone:781-259-9292
Practice Address - Fax:781-259-0747
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75595207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3144399Medicaid
MA3144399Medicaid
MAJ13485Medicare ID - Type Unspecified