Healthcare Provider Details

I. General information

NPI: 1568432102
Provider Name (Legal Business Name): RICHARD LUCARELLI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 DUTCH FORK RD
IRMO SC
29063-8725
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 803-749-8900
  • Fax: 803-749-8899
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number287
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: