Individual
WALTER DELUCA
Active
Individual
WALTER DELUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
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
Update your record
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