Provider Demographics
NPI:1457431637
Name:LUCIANO, MICHAEL C (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:LUCIANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:882 JACKSONVILLE RD.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:IVYLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4836
Mailing Address - Country:US
Mailing Address - Phone:215-957-1100
Mailing Address - Fax:215-957-1111
Practice Address - Street 1:882 JACKSONVILLE RD.
Practice Address - Street 2:SUITE 204
Practice Address - City:IVYLAND
Practice Address - State:PA
Practice Address - Zip Code:18974
Practice Address - Country:US
Practice Address - Phone:215-957-1100
Practice Address - Fax:215-957-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine