Healthcare Provider Details

I. General information

NPI: 1881992865
Provider Name (Legal Business Name): JEFFREY LUCCHINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 CLEVELAND DR
LOWER BURRELL PA
15068-3349
US

IV. Provider business mailing address

508 CLEVELAND DR
LOWER BURRELL PA
15068-3349
US

V. Phone/Fax

Practice location:
  • Phone: 724-994-8147
  • Fax:
Mailing address:
  • Phone: 724-994-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number133VN1006X
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: