Provider Demographics
NPI:1548207558
Name:KOLM, LUKAS R (MD)
Entity Type:Individual
Prefix:
First Name:LUKAS
Middle Name:R
Last Name:KOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 WATER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3240
Mailing Address - Country:US
Mailing Address - Phone:603-498-9634
Mailing Address - Fax:
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:WENTWORTH DOUGLASS HOSPITAL
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-498-9634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210087207P00000X
NH11324207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30201580Medicaid
NH01Y003235NH01OtherBCBS
NH930108812OtherRAILROAD MCARE
MA110003415AMedicaid
NH30201580Medicaid
NH30201580Medicaid
NH930108812OtherRAILROAD MCARE