Healthcare Provider Details

I. General information

NPI: 1306836895
Provider Name (Legal Business Name): JAMES MICHAEL LUCHETTI MD, FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIRCLE DEPARTMENT OF PEDIATRICS
PORTSMOUTH VA
23704
US

IV. Provider business mailing address

826 BOTETOURT GARDENS
NORFOLK VA
23507
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-4270
  • Fax:
Mailing address:
  • Phone: 757-291-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number0101057295
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: