Provider Demographics
NPI:1841235686
Name:LUKOFF, MARSHALL L (DPM)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:L
Last Name:LUKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:1D
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-479-7921
Mailing Address - Fax:617-774-1458
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:1D
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-479-7921
Practice Address - Fax:617-774-1458
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1498213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0334081Medicaid
MA0334081Medicaid
MAT57915Medicare UPIN
MAY70616Medicare ID - Type UnspecifiedINDIVIDUAL