Healthcare Provider Details

I. General information

NPI: 1487444170
Provider Name (Legal Business Name): ROBERT LUKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 FAIRVIEW STREET
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

51 FAIRVIEW ST
BRATTLEBORO VT
05301-6629
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-6028
  • Fax: 802-254-7501
Mailing address:
  • Phone: 802-254-6028
  • Fax: 802-254-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136614
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: