Provider Demographics
NPI:1770593469
Name:LUCCHESE, MARIA (DPM)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:LUCCHESE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 SHEPHERD MOUNTAIN CV APT 509
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-4902
Mailing Address - Country:US
Mailing Address - Phone:646-320-8212
Mailing Address - Fax:
Practice Address - Street 1:6000 SHEPHERD MOUNTAIN CV APT 509
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-4902
Practice Address - Country:US
Practice Address - Phone:646-320-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1802213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery