Healthcare Provider Details

I. General information

NPI: 1740542372
Provider Name (Legal Business Name): JORGE L LIPORACI-LUCENA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD SUITE 3301
NEWARK DE
19713-2072
US

IV. Provider business mailing address

4601 FLAT ROCK RD APT 301
PHILADELPHIA PA
19127-2027
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 302-623-4375
Mailing address:
  • Phone: 267-385-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT189425
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0010558
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberC1-0010558
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: