Provider Demographics
NPI:1043372410
Name:LUCAN, SEAN CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CHRISTIAN
Last Name:LUCAN
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 1:3011 BOSTON RD
Mailing Address - Street 2:WILLIAMSBRIDGE FAMILY PRACTICE CENTER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469
Mailing Address - Country:US
Mailing Address - Phone:718-547-6111
Mailing Address - Fax:
Practice Address - Street 1:3011 BOSTON RD
Practice Address - Street 2:WILLIAMSBRIDGE FAMILY PRACTICE CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4002
Practice Address - Country:US
Practice Address - Phone:718-547-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253590-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine