Provider Demographics
NPI:1851350854
Name:PLUTO, LUKE A (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:A
Last Name:PLUTO
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 1:100 FODEN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2327
Mailing Address - Country:US
Mailing Address - Phone:207-828-1122
Mailing Address - Fax:207-828-0188
Practice Address - Street 1:100 FODEN RD STE 103
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2327
Practice Address - Country:US
Practice Address - Phone:207-828-1122
Practice Address - Fax:207-828-0188
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034724207R00000X, 207RP1001X
IDM-7228207R00000X, 207RP1001X
MEMD22294207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00367294OtherRAILROAD MEDICARE
WA1123389Medicaid
ID804124700Medicaid
WA0215165OtherLABOR & INDUSTRIES
WAG8862338Medicare PIN
C44610Medicare UPIN
WA0215165OtherLABOR & INDUSTRIES