Provider Demographics
NPI:1194864785
Name:NIXON, LUCIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:J
Last Name:NIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:326 VANDERBILT PKWY
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5856
Mailing Address - Country:US
Mailing Address - Phone:917-471-2381
Mailing Address - Fax:718-245-7469
Practice Address - Street 1:594 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1706
Practice Address - Country:US
Practice Address - Phone:718-245-7353
Practice Address - Fax:718-245-7469
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY165653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30K101Medicare ID - Type UnspecifiedPART B
NYF21229Medicare UPIN