Healthcare Provider Details

I. General information

NPI: 1851350854
Provider Name (Legal Business Name): LUKE A PLUTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD STE 103
SOUTH PORTLAND ME
04106-2327
US

IV. Provider business mailing address

100 FODEN RD STE 103
SOUTH PORTLAND ME
04106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-1122
  • Fax: 207-828-0188
Mailing address:
  • Phone: 207-828-1122
  • Fax: 207-828-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00034724
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-7228
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD00034724
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM-7228
License Number StateID
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD22294
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: