Basic Information
| Provider Information | |||||||||
| NPI: | 1558350405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCIANO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | A | ||||||||
| 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: | 8602766020 | ||||||||
| FaxNumber: | 8602766059 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 WEST ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SOUTHINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064896025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602766043 | ||||||||
| FaxNumber: | 8602766059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VE0102X | 17123 | CT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 010017123CT 05 | 01 | CT | ANTHEM BLUE CROSE & BLUE | OTHER | 2V5829 | 01 | CT | HEALTH NET | OTHER | 3786055 | 01 | AETNA USHEALTH CARE | OTHER | 010017123CT 04 | 01 | CT | ANTHEM BLUE CROSE & BLUE | OTHER | 0011711230 | 05 | CT | MEDICAID | 20-1997579 | 01 | CT | PRIVATE HEALTH CARE SYSTE | OTHER | HAS392 | 01 | CT | OXFORD HEALTH | OTHER | 0152719 | 01 | CT | CIGNA -1-800-244-6224 | OTHER | 001171230-03NB | 01 | CT | ANTHEM BLUE CARE FAMILY P | OTHER | 001171230-04HTFD | 01 | CT | ANTHEM BLUE CARE FAMILY P | OTHER | 20-1997579 | 01 | CT | UNITED HEALTH CARE | OTHER |