Provider Demographics
NPI:1740547058
Name:LUCUARA REVELO, PAULA ANDREA (MD)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:LUCUARA REVELO
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 1:800 CONNECTICUT BLVD
Mailing Address - Street 2:UCONN MEDICAL GROUP
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-282-3859
Mailing Address - Fax:860-282-8574
Practice Address - Street 1:800 CONNECTICUT BLVD
Practice Address - Street 2:UCONN MEDICAL GROUP
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-282-3859
Practice Address - Fax:860-282-8574
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054445208000000X
390200000X
NJ25MA10527900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program