Provider Demographics
NPI:1114134442
Name:LUCK, KATHRYN COURTNEY (PA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:COURTNEY
Last Name:LUCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAHEY HOSPITAL & MEDICAL CENTER
Mailing Address - Street 2:41 MALL ROAD
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8650
Mailing Address - Fax:781-744-5345
Practice Address - Street 1:LAHEY MEDICAL CENTER, PEABODY
Practice Address - Street 2:1 ESSEX CENTER DRIVE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2901
Practice Address - Country:US
Practice Address - Phone:978-538-4267
Practice Address - Fax:978-538-4706
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP0969Medicare PIN
MAS74050Medicare UPIN