Provider Demographics
NPI:1164953378
Name:LUCARIELLO, RICHARD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:LUCARIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 BRAGGS WAY UNIT 4416
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4684
Mailing Address - Country:US
Mailing Address - Phone:914-886-3705
Mailing Address - Fax:
Practice Address - Street 1:5046 HIGHWAY 17 BYP S STE 200
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4503
Practice Address - Country:US
Practice Address - Phone:843-449-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272812207N00000X
SC90275207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology