Provider Demographics
NPI:1457377681
Name:LUCHTMAN-JONES, LORI A (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LUCHTMAN-JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 11009
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-0278
Mailing Address - Fax:513-636-7951
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 11009
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-0278
Practice Address - Fax:513-636-7951
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1053172080P0207X
MDD0066982080P0207X
VA01012425802080P0207X
DCMD0369672080P0207X
OH35.1254462080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208084806Medicaid
MO19361OtherBLUE SHIELD
IL036081107Medicaid
152010381Medicare PIN
MO208084806Medicaid