MEDICARE: DR. SALVATORE JOSEPH LUCIDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01052044A	IN
2	2083A0100X	Aerospace Medicine Physician	01052044A	IN

General Provider Information

NPI Number	:	1811980451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALVATORE JOSEPH LUCIDO MD

Provider Business Mailing Address
First Line	:	3280 MITCHELL BLVD CREDENTIALS OFFICE
Second Line	:
City	:	MOODY AFB
State	:	GA
Zip	:	31699-1500
Country	:	US
Telephone Number	:	229-257-1459
Fax Number	:

Provider Business Practice Location Address
First Line	:	3280 MITCHELL BLVD
Second Line	:	23 AMDS/FLIGHT MEDICINE CLINIC
City	:	MOODY AFB
State	:	GA
Zip	:	31699-1500
Country	:	US
Telephone Number	:	229-257-2103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	05/06/2022

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