Provider Demographics
NPI:1548351901
Name:TLUCKO, ALENA C (MD)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:C
Last Name:TLUCKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MORRILL PL
Mailing Address - Street 2:SUITE 9
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-3598
Mailing Address - Country:US
Mailing Address - Phone:978-388-5050
Mailing Address - Fax:978-388-4035
Practice Address - Street 1:24 MORRILL PL
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-3530
Practice Address - Country:US
Practice Address - Phone:978-388-5050
Practice Address - Fax:978-388-4035
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110054929AMedicaid
MA110054929AMedicaid
MAJ30786Medicare ID - Type Unspecified