Provider Demographics
NPI:1942231691
Name:LUCCHESI, KENT G (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:G
Last Name:LUCCHESI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K. GREGORY
Other - Middle Name:
Other - Last Name:LUCCHESI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7 PARKWAY CTR
Mailing Address - Street 2:SUITE 375
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220
Mailing Address - Country:US
Mailing Address - Phone:412-937-5700
Mailing Address - Fax:412-937-5739
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514
Practice Address - Country:US
Practice Address - Phone:574-523-3193
Practice Address - Fax:574-523-3464
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040256207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79529Medicare UPIN