Provider Demographics
NPI:1821626557
Name:DELUCIA, MICHAEL WOOD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WOOD
Last Name:DELUCIA
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 1:38 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2514
Mailing Address - Country:US
Mailing Address - Phone:802-356-9121
Mailing Address - Fax:
Practice Address - Street 1:300 PROFESSIONAL DR STE 2B
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8897
Practice Address - Country:US
Practice Address - Phone:207-883-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD27120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine