Provider Demographics
NPI:1326020827
Name:LUCCHINA, LESLIE CAROLINE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CAROLINE
Last Name:LUCCHINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-1215
Mailing Address - Country:US
Mailing Address - Phone:617-557-4897
Mailing Address - Fax:
Practice Address - Street 1:160 COMMONWEALTH AVE
Practice Address - Street 2:UNIT 6A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2707
Practice Address - Country:US
Practice Address - Phone:617-262-3376
Practice Address - Fax:617-262-0834
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75286207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075286OtherTUFTS HEALTH PLAN
MAJ12725OtherBCBS MA
MAA30238Medicare ID - Type Unspecified
MA075286OtherTUFTS HEALTH PLAN