Provider Demographics
NPI:1578506101
Name:CICCHINELLI, LUKE DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:LUKE
Middle Name:DAVID
Last Name:CICCHINELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3520
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:1111 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:480-242-5177
Practice Address - Fax:252-744-3616
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC361213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890802HMedicaid
NC480031159OtherRAILROAD MEDICARE
NC0802HOtherBCBS NC
NC480031159OtherRAILROAD MEDICARE
NC890802HMedicaid