Provider Demographics
NPI:1154326387
Name:DELUCA, THOMAS J (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DELUCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2100
Mailing Address - Country:US
Mailing Address - Phone:207-364-7831
Mailing Address - Fax:207-369-9467
Practice Address - Street 1:431 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2100
Practice Address - Country:US
Practice Address - Phone:207-364-7831
Practice Address - Fax:207-369-9467
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-02-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
ME1450207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5356Medicare UPIN
MEF16875Medicare UPIN