Provider Demographics
NPI:1972557254
Name:PLUCKER, PAUL RICHARD (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:PLUCKER
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-4721
Mailing Address - Country:US
Mailing Address - Phone:724-537-3706
Mailing Address - Fax:
Practice Address - Street 1:433 FRYE FARM RD
Practice Address - Street 2:CENTRAL MEDICAL ARTS BLDG
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6480
Practice Address - Country:US
Practice Address - Phone:724-539-3750
Practice Address - Fax:724-539-3751
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000051L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02615OtherHEAR USA #
PA0420476OtherGP# FOR UMWA FOR REPAIRS
PA129034OtherUMWA PROV.# FOR TESTING
PA209368OtherUPMC GROUP #
PA209368OtherGROUP# FOR UPMC
PAPL215605OtherBLUE SHIELD PROVIDER #
PAGPCEOtherRAILROAD MEDICARE GP#
PA27026OtherGROUP#FOR HEALTH ASSUR.,
PA32262OtherHEALTH AMERICA,ADVANTRA #
PA490552OtherAETNA PROVIDER #
PAGPCEOtherRAILROAD MEDICARE GP#
PA215605Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER