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Individual
MATTHEW J LUCOSTIC
Active
Individual
MATTHEW J LUCOSTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP012852
PA
363LF0000X
Family Nurse Practitioner
Primary
97970
WV
363LF0000X
Family Nurse Practitioner
SP012852
PA
Other
Enumeration date
04/17/2013
Last updated
04/08/2022
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