Provider Demographics
NPI:1699909747
Name:MICHAEL W. LUCARELLI D.O.,INC.
Entity type:Organization
Organization Name:MICHAEL W. LUCARELLI D.O.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUCARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-471-6850
Mailing Address - Street 1:3461 S COUNTY TRL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1463
Mailing Address - Country:US
Mailing Address - Phone:401-471-6850
Mailing Address - Fax:401-471-6855
Practice Address - Street 1:3461 S COUNTY TRL
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1463
Practice Address - Country:US
Practice Address - Phone:401-471-6850
Practice Address - Fax:401-471-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00491261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
089002947OtherMEDICARE