MEDICARE: PAUL RICHARD PLUCKER M.S., CCC-A

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	237600000X	Audiologist-Hearing Aid Fitter	AT000051L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	GPCE	OTHER	PA	RAILROAD MEDICARE GP#

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02615	OTHER	PA	HEAR USA #
2	0420476	OTHER	PA	GP# FOR UMWA FOR REPAIRS
3	129034	OTHER	PA	UMWA PROV.# FOR TESTING
4	209368	OTHER	PA	UPMC GROUP #
5	209368	OTHER	PA	GROUP# FOR UPMC
6	PL215605	OTHER	PA	BLUE SHIELD PROVIDER #
8	27026	OTHER	PA	GROUP#FOR HEALTH ASSUR.,
9	32262	OTHER	PA	HEALTH AMERICA,ADVANTRA #
10	490552	OTHER	PA	AETNA PROVIDER #

General Provider Information

NPI Number	:	1972557254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL RICHARD PLUCKER M.S., CCC-A

Provider Business Mailing Address
First Line	:	1000 VALLEYVIEW DR
Second Line	:
City	:	LATROBE
State	:	PA
Zip	:	15650-4721
Country	:	US
Telephone Number	:	724-537-3706
Fax Number	:

Provider Business Practice Location Address
First Line	:	433 FRYE FARM RD
Second Line	:	CENTRAL MEDICAL ARTS BLDG
City	:	GREENSBURG
State	:	PA
Zip	:	15601-6480
Country	:	US
Telephone Number	:	724-539-3750
Fax Number	:	724-539-3751

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/09/2007

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