Provider Demographics
NPI:1801944236
Name:DELUCA, PAUL P (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:P
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:130 DANIEL DRIVE
Mailing Address - Street 2:PO BOX 129
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0129
Mailing Address - Country:US
Mailing Address - Phone:859-236-2222
Mailing Address - Fax:859-236-2227
Practice Address - Street 1:130 DANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40423-0129
Practice Address - Country:US
Practice Address - Phone:859-236-2222
Practice Address - Fax:859-236-2227
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26523208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64265234Medicaid
KY1270906Medicare PIN
D45211Medicare UPIN