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NPI Code Detail

MEDICARE: MRS. GINA LUCARELLI WILBER PA-C

MEDICARE:  MRS. GINA LUCARELLI WILBER  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5264CT
2363AM0700XMedical Physician Assistant5264CT
32084P0805XGeriatric Psychiatry Physician005264CT

General Provider Information

NPI Number : 1073180550
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GINA LUCARELLI WILBER PA-C
Provider Business Mailing Address
First Line : 80 CLUB DR
Second Line :
City : BERLIN
State : CT
Zip : 06037-1132
Country : US
Telephone Number : 860-221-5556
Fax Number :
Provider Business Practice Location Address
First Line : 27 RANDOLPH RD
Second Line :
City : HOWELL
State : NJ
Zip : 07731-8611
Country : US
Telephone Number : 866-415-8251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2021
Last Update Date : 10/31/2022

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Directions to “ MRS. GINA LUCARELLI WILBER PA-C” Practice Location

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