Provider Demographics
NPI:1154607117
Name:JOSEPH A. DELUCCA, DPM, LLC
Entity type:Organization
Organization Name:JOSEPH A. DELUCCA, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELUCCA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-831-2671
Mailing Address - Street 1:3101 RIDGELAKE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4926
Mailing Address - Country:US
Mailing Address - Phone:504-831-2671
Mailing Address - Fax:504-831-2646
Practice Address - Street 1:3101 RIDGELAKE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4926
Practice Address - Country:US
Practice Address - Phone:504-831-2671
Practice Address - Fax:504-831-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPMPD025R213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1324001Medicaid
LA1558425033OtherINDIVIDUAL NPI
LA826480248OtherRAILROAD MEDICARE
LA03979OtherBLUE CROSS - LOUISIANA
LA826480248OtherRAILROAD MEDICARE
LA56179Medicare PIN