Provider Demographics
NPI:1962402024
Name:MCLUCKIE, ALAN E (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:E
Last Name:MCLUCKIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2762 ELECTRIC RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3582
Mailing Address - Country:US
Mailing Address - Phone:540-283-2710
Mailing Address - Fax:
Practice Address - Street 1:2762 ELECTRIC RD STE A
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3582
Practice Address - Country:US
Practice Address - Phone:540-283-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232789207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5880912Medicaid
VA5880513Medicaid
VA010248434Medicaid
VA060070695Medicare PIN
VAH75982Medicare UPIN
VA000294P99Medicare ID - Type Unspecified
VA009833S57Medicare PIN
VA000638C19Medicare PIN