Individual
WALTER DELUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
684 WARREN AVE, EAST PROVIDENCE, RI 02914-1405
(401) 434-0022
(401) 434-6111
Mailing address
684 WARREN AVE, EAST PROVIDENCE, RI 02914-1405
(401) 434-0022
(401) 434-6111
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
289
MT
363AM0700X
Medical Physician Assistant
Primary
PA00002
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000096303
BLUE CROSS NUMBER
MT
05
—
0438260
—
MT
01
—
289
STATE LIC NUMBER
MT
05
—
7005920
—
RI
01
—
979006386
MEDICARE PTAN
RI
Enumeration date
10/04/2006
Last updated
09/18/2018
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