Provider Demographics
NPI:1538372198
Name:LUCCIOLI, STEFANO (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANO
Middle Name:
Last Name:LUCCIOLI
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 1:527 MAPLE AVE E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4746
Mailing Address - Country:US
Mailing Address - Phone:703-938-3900
Mailing Address - Fax:703-938-9391
Practice Address - Street 1:527 MAPLE AVE E
Practice Address - Street 2:SUITE 300
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4746
Practice Address - Country:US
Practice Address - Phone:703-938-3900
Practice Address - Fax:703-938-9391
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056775174400000X
MDD0059615174400000X
DCMD30062207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01009Medicare ID - Type Unspecified
I08303Medicare UPIN