Provider Demographics
NPI:1295709376
Name:LUCK, CYNTHIA ESTELLE (DO)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ESTELLE
Last Name:LUCK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342-1351
Mailing Address - Country:US
Mailing Address - Phone:724-873-8740
Mailing Address - Fax:724-873-8745
Practice Address - Street 1:201 S JOHNSON RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:PA
Practice Address - Zip Code:15342-1351
Practice Address - Country:US
Practice Address - Phone:724-873-8740
Practice Address - Fax:724-873-8745
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101152233Medicaid
PA087640Medicare PIN
PA101152233Medicaid