WALTER DELUCA (NPI# 1962598516) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962598516 |
| Entity Type | Individual |
| Full Name | WALTER DELUCA |
| Credential | PAC |
| Practice Address |
684 Warren Ave East Providence RI 02914-1405 |
| Practice Telephone | 4014340022 |
| Practice Fax Number | 4014346111 |
| Mailing Telephone | 4014340022 |
| Mailing Fax Number | 4014346111 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2018-09-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00002 | RI | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
289 | MT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | 7005920 | 05 | |
| MT | BLUE CROSS NUMBER | 000096303 | 01 |
| MT | 0438260 | 05 | |
| MT | STATE LIC NUMBER | 289 | 01 |
| RI | MEDICARE PTAN | 979006386 | 01 |
| Street Address |
684 WARREN AVE |
| City | EAST PROVIDENCE |
| State | RI |
| Zip Code | 02914-1405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790260974 | Primary Walk-in Medical Urgent Care LLC | Clinic/Center | 684 Warren Ave, East Providence, RI 02914-1405 | 2018-10-03 |
| 1225444243 | Primary Medical Center and Walk-in LLC | Clinic/Center | 684 Warren Ave, East Providence, RI 02914-1405 | 2014-07-10 |
| 1720426646 | Andrew Francis Moody | Physician Assistant | 684 Warren Ave, East Providence, RI 02914-1405 | 2013-06-13 |
| 1518056795 | Angelo Carpethos | Physician Assistant | 684 Warren Ave, East Providence, RI 02914-1405 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457988198 | Sean C. Duffy | Massage Therapist | 231 Warren Ave., East Providence, RI 02914 | 2020-03-24 |
| 1457905606 | Jeanine Le-kreuzer, Lmhc | Clinic/Center | 3421 Pawtucket Ave, East Providence, RI 02914 | 2019-07-26 |
| 1881113983 | Megan Grace Fitzpatrick | Student in an Organized Health Care Education/Training Program | 51 Milburn Rd, East Providence, RI 02914 | 2017-09-11 |
| 1265719660 | Hilary Elise Bicknell | Physical Therapist | 927 B Warren Ave, East Providence, RI 02914 | 2011-11-14 |
| 1346549037 | Amanda M Hope | Occupational Therapist | 2680 Pawtucket Ave, East Providence, RI 02914 | 2011-03-21 |
| 1780993824 | Shannon Hayes | Physical Therapist | 400 Massaoit Ave, East Providence, RI 02914 | 2010-10-06 |
| 1053623538 | Ricardo Rafael Correa Marquez | Internal Medicine | 900 Warren Avenue, Suite 300, East Providence, RI 02914 | 2010-07-13 |
| 1013231570 | Michael Seidler | Internal Medicine | 20 Catamore Blvd., East Providence, RI 02914 | 2010-03-26 |
| 1053543405 | Ray Rezania | Dentist | 1055 South Broadway, East Providence, RI 02914 | 2009-08-19 |
| 1144464587 | John F Maynard | Urology | Metacomet Office Park, 450 Veterans Parkway, East Providence, RI 02914 | 2009-04-29 |
| Find all providers in zip 02914 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184723520 | Steven A Occhiuti | Physician Assistant | 1 Office Parkway, Suite 201, East Providence, RI 02914 | 2006-09-22 |
| 1801363809 | Michael Antoine | Physician Assistant | 400 Massasoit Ave Ste 300, East Providence, RI 02914-2012 | 2018-10-28 |
| 1518056795 | Angelo Carpethos | Physician Assistant | 684 Warren Ave, East Providence, RI 02914-1405 | 2006-10-12 |
| 1093814931 | Toby Fingeroth Weiser | Physician Assistant | 900 Warren Ave, Suite 401, East Providence, RI 02914-1430 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285243311 | Sara Lafreniere | Physician Assistant | 18 Millers Brook Dr, Cumberland, RI 02864-6132 | 2020-07-24 |
| 1962962589 | Delaney Horsley | Physician Assistant | 472 W Fountain St Apt 1, Providence, RI 02903-3570 | 2019-03-20 |
| 1154807717 | Ocean State Primary, LLC | Physician Assistant | 300 Toll Gate Rd Ste 101b, Warwick, RI 02886-4447 | 2018-07-17 |
| 1447753728 | Joseph Desrosiers II | Physician Assistant | 712 Putnam Pike Unit 2, Chepachet, RI 02814-1404 | 2018-03-13 |
| 1346698024 | Samantha Lea Colli | Physician Assistant | 100 Dudley St Fl 3, Providence, RI 02905 | 2016-06-02 |
| 1285988790 | Silver Spring Health Care Management, Inc. | Physician Assistant | 70 Kenyon Ave Unit 321, Wakefield, RI 02879 | 2012-11-06 |
| 1275601056 | Michael Anthony Mcgourty | Physician Assistant | 93 Thames St, Newport, RI 02840-2536 | 2006-12-01 |
| 1629168901 | Ri Departmenf of Corrections | Physician Assistant | 39 Howard Ave, Cranston, RI 02920-3001 | 2006-10-15 |
| 1225138597 | Hope Ellen Burns | Physician Assistant | 1145 Main St, Pawtucket, RI 02860-4807 | 2006-09-25 |
| 1073530861 | Stephanie M Maclary | Physician Assistant | 3 Wake Robin Rd, Lincoln, RI 02865-4294 | 2006-07-16 |
| Find all providers with the same taxonomy | ||||
| City | EAST PROVIDENCE |
| Zip Code | 02914 |
Please comment or provide details below to improve the information on WALTER DELUCA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.