Provider Demographics
NPI:1891716437
Name:DELUCA, LINDA A (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:DELUCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 OLD RIVER RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865
Mailing Address - Country:US
Mailing Address - Phone:401-334-1044
Mailing Address - Fax:401-334-1054
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-334-1044
Practice Address - Fax:401-334-1054
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI6572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200583OtherBLUE CROSS
RI004303OtherBLUE CHIP
F09629Medicare UPIN
RI200583OtherBLUE CROSS