Provider Demographics
NPI:1851516090
Name:LUCCI, HEATHER KASPER (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KASPER
Last Name:LUCCI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:KASPER LUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8150 PERRY HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5200
Mailing Address - Country:US
Mailing Address - Phone:412-369-9550
Mailing Address - Fax:412-369-9566
Practice Address - Street 1:1140 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2160
Practice Address - Country:US
Practice Address - Phone:412-364-4402
Practice Address - Fax:412-364-3850
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103366097-0002Medicaid
PA103366097-0001Medicaid