Provider Demographics
NPI:1710976360
Name:LUCENTE, JULIA IMMACULATA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:IMMACULATA
Last Name:LUCENTE
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 1:215 COLONIAL LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2174
Mailing Address - Country:US
Mailing Address - Phone:937-433-3313
Mailing Address - Fax:
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-395-4893
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052717L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599857Medicaid
LU4026151Medicare ID - Type Unspecified
OH0599857Medicaid