Basic Information
| Provider Information | |||||||||
| NPI: | 1447239413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCIANO | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060302212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792792 | ||||||||
| FaxNumber: | 8606791494 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 WEST ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064896025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602766043 | ||||||||
| FaxNumber: | 8602766059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 043408 | CT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7253733 | 01 | CO | AETNA | OTHER | 001434084 | 05 | CT | MEDICAID | 010043408 CT 01 | 01 | CT | ANTHEM BC & BS NB OFFICE | OTHER | 010043408 CT 02 | 01 | ANTHEM BC & BS HTFD. OFF | OTHER | 294113 | 01 | CT | WELLCARE PREFERRED ONE | OTHER | 2V7377 | 01 | CT | HEALTHNET | OTHER | 20-1997579 | 01 | CT | UNITED HEALTH CARE | OTHER | 20-1997579 | 01 | CT | PRIVATE HEALTH CARE SYSTE | OTHER | 20-1997579 | 01 | CT | COMMUNITY HEALTH NETWORK | OTHER |