Provider Demographics
NPI:1942208392
Name:LUCHETTI, WAYNE THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:THOMAS
Last Name:LUCHETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:610-807-0366
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057357L207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01210001OtherKEYSTONE HEALTH CENTRAL
0870150000OtherINDEPENDENCE BLUE CROSS
1879164OtherUNITED HEALTHCARE
810225603OtherPRIVATE HEALTHCARE SYSTEM
PA0018481920001Medicaid
7613315OtherCIGNA HEALTHCARE
328817OtherHEALTH AMERICA/HEALTH ASS
01210001OtherCAPITAL BLUE CROSS
0870150000OtherAMERIHEALTH
0870150000OtherKEYSTONE HEALTH EAST
2581586OtherAETNA PPO
924697OtherFIRST PRIORITY LIFE INS.
P2531935OtherOXFORD HEALTH PLANS
200040875OtherRAILROAD MEDICARE
77834OtherGEISINGER HEALTH PLAN
819554OtherFIRST PRIORITY HEALTH
924697OtherHIGHMARK BLUE SHIELD
PAG97441Medicare UPIN
0870150000OtherKEYSTONE HEALTH EAST