Healthcare Provider Details

I. General information

NPI: 1962402024
Provider Name (Legal Business Name): ALAN E MCLUCKIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 01/24/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2762 ELECTRIC RD STE A
ROANOKE VA
24018-3582
US

IV. Provider business mailing address

2762 ELECTRIC RD STE A
ROANOKE VA
24018-3582
US

V. Phone/Fax

Practice location:
  • Phone: 540-283-2710
  • Fax:
Mailing address:
  • Phone: 540-283-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101232789
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101232789
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101232789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: