Provider Demographics
NPI:1609851583
Name:LACY, HILTON R (MD)
Entity Type:Individual
Prefix:
First Name:HILTON
Middle Name:R
Last Name:LACY
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 1:502 OLD LYNCHBURG RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6550
Mailing Address - Country:US
Mailing Address - Phone:434-970-1543
Mailing Address - Fax:434-972-1831
Practice Address - Street 1:500 OLD LYNCHBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6500
Practice Address - Country:US
Practice Address - Phone:434-972-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010476622084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA088531OtherSENTARA
VA378228OtherMAMSI
VA7118716Medicaid
VA2011654OtherCIGNA
VAVV7295AOtherMEDICARE PTAN
VA206019OtherMANAGED HEALTH NETWORK
VA255060000OtherMAGELLAN
VA236368OtherANTHEM BCBS
VA249648OtherVALUE OPTIONS
VA604718OtherVIRGINIA HEALTH NETWORK
VA504967OtherPRIVATE HEALTHCARE SYSTEM
VA7134107OtherAETNA
VA190000704Medicare ID - Type Unspecified
VA7118716Medicaid