Provider Demographics
NPI:1740542372
Name:LIPORACI-LUCENA, JORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:LIPORACI-LUCENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4601 FLAT ROCK RD
Mailing Address - Street 2:APT 301
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-2027
Mailing Address - Country:US
Mailing Address - Phone:267-385-6113
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 3301
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-623-4370
Practice Address - Fax:302-623-4375
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT189425208600000X
DEC1-0010558208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery