Provider Demographics
NPI:1386634830
Name:LUCK, STEPHEN C (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:LUCK
Suffix:
Gender:
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:MEDSTAR SURGERY CENTER @ LAFAYETTE CENTRE
Mailing Address - Street 2:1133 21ST STR., NW, SUITE 1000
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036
Mailing Address - Country:US
Mailing Address - Phone:202-416-2145
Mailing Address - Fax:202-416-2108
Practice Address - Street 1:MEDSTAR SURGERY CENTER AT LAFAYETTE CENTRE
Practice Address - Street 2:1133 21ST STR., NW, SUITE 1000
Practice Address - City:WASHINGTON, DC
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-416-2145
Practice Address - Fax:202-223-9047
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053390207L00000X
MDD57523207L00000X
DCMD20762207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F87095Medicare UPIN
406810T76Medicare ID - Type Unspecified