Provider Demographics
NPI:1417924218
Name:LUCAS, WILLIAM EWING
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EWING
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 1:32 POINT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1620
Mailing Address - Country:US
Mailing Address - Phone:508-991-7888
Mailing Address - Fax:
Practice Address - Street 1:1145 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6634
Practice Address - Country:US
Practice Address - Phone:508-990-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3116328Medicaid
MAJ12944Medicare PIN
MAD24967Medicare UPIN