Provider Demographics
NPI:1336458298
Name:MCCARTHY, ANGELA LUCAS (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LUCAS
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1903 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3713
Mailing Address - Country:US
Mailing Address - Phone:813-344-1084
Mailing Address - Fax:813-803-5444
Practice Address - Street 1:1903 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3713
Practice Address - Country:US
Practice Address - Phone:813-344-1084
Practice Address - Fax:813-803-5444
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156701207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine