Individual
MR. LUKE DAVID CICCHINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 LOCUST STREET, PHILADELPHIA, PA 19107
(480) 242-5177
(252) 744-3616
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
(252) 744-3520
(252) 744-3194
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
361
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0802H
BCBS NC
NC
01
—
480031159
RAILROAD MEDICARE
NC
05
—
890802H
—
NC
Enumeration date
06/13/2006
Last updated
01/20/2017
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