Provider Demographics
NPI:1235110677
Name:LACYONI MORAES, MD, PC
Entity Type:Organization
Organization Name:LACYONI MORAES, MD, PC
Other - Org Name:ABINGDON HEART CARE AND PREVENTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LACYONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-676-2211
Mailing Address - Street 1:390 COMMERCE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-3876
Mailing Address - Country:US
Mailing Address - Phone:276-676-2211
Mailing Address - Fax:276-676-0966
Practice Address - Street 1:390 COMMERCE DR
Practice Address - Street 2:SUITE A
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-3876
Practice Address - Country:US
Practice Address - Phone:276-676-2211
Practice Address - Fax:276-676-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225620261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA461930OtherANTHEM GROUP
VAP00055669OtherRR MEDICARE
VA461930OtherANTHEM GROUP