Provider Demographics
NPI:1841247756
Name:LUCK, LORI RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:RENEE
Last Name:LUCK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:ERIE AVE AT FRONT ST
Mailing Address - Street 2:DEPARTMENT OF HEMATOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1095
Mailing Address - Country:US
Mailing Address - Phone:215-427-5096
Mailing Address - Fax:215-427-6684
Practice Address - Street 1:ERIE AVE AT FRONT ST
Practice Address - Street 2:DEPARTMENT OF HEMATOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1095
Practice Address - Country:US
Practice Address - Phone:215-427-5096
Practice Address - Fax:215-427-6684
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4245112080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010867820001Medicaid
PA080786Medicare ID - Type Unspecified
PA1010867820001Medicaid