Provider Demographics
NPI:1548604143
Name:FON, LUCAS
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:
Last Name:FON
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 1:5207 MELWOOD PARK AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7427
Mailing Address - Country:US
Mailing Address - Phone:240-461-8569
Mailing Address - Fax:
Practice Address - Street 1:5207 MELWOOD PARK AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-7427
Practice Address - Country:US
Practice Address - Phone:240-461-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health