Provider Demographics
NPI:1669709390
Name:LUCCO, ANGELO JOHN (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:JOHN
Last Name:LUCCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 MOUNT NEBO RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9237
Mailing Address - Country:US
Mailing Address - Phone:570-223-8842
Mailing Address - Fax:570-223-8842
Practice Address - Street 1:210 MOUNT NEBO RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9237
Practice Address - Country:US
Practice Address - Phone:570-223-8842
Practice Address - Fax:570-223-8842
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD069604L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine