MEDICARE: DR. CYNTHIA ESTELLE LUCK DO

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
1	207Q00000X	Family Medicine Physician	OS012509	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295709376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA ESTELLE LUCK DO

Provider Business Mailing Address
First Line	:	201 S JOHNSON RD
Second Line	:
City	:	HOUSTON
State	:	PA
Zip	:	15342-1351
Country	:	US
Telephone Number	:	724-873-8740
Fax Number	:	724-873-8745

Provider Business Practice Location Address
First Line	:	201 S JOHNSON RD
Second Line	:
City	:	HOUSTON
State	:	PA
Zip	:	15342-1351
Country	:	US
Telephone Number	:	724-873-8740
Fax Number	:	724-873-8745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	05/01/2009

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