Provider Demographics
NPI:1093241481
Name:LUCAS, ERWIN JOSEPH CORONACION
Entity Type:Individual
Prefix:
First Name:ERWIN JOSEPH
Middle Name:CORONACION
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7826 PARKE WEST DR APT 104
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4737
Mailing Address - Country:US
Mailing Address - Phone:410-739-5719
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 615
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3291
Practice Address - Country:US
Practice Address - Phone:410-766-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist