Healthcare Provider Details

I. General information

NPI: 1134353220
Provider Name (Legal Business Name): MARY PATRICIA LUCCHESI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 207
RICHMOND VA
23226-1930
US

IV. Provider business mailing address

5855 BREMO RD SUITE 207
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-3079
  • Fax: 804-282-6159
Mailing address:
  • Phone: 804-288-3079
  • Fax: 804-282-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number62858
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101251805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: