Provider Demographics
NPI:1730140633
Name:LUXARDO, KARL O (DO)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:O
Last Name:LUXARDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:2407 REICHART RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8969
Practice Address - Country:US
Practice Address - Phone:570-784-8303
Practice Address - Fax:570-387-5030
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS010656L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001822614Medicaid
H27975Medicare UPIN