Provider Demographics
NPI:1669483798
Name:LUCAS, PAMELA ANNE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:MECHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7435 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3406
Mailing Address - Country:US
Mailing Address - Phone:757-772-8101
Mailing Address - Fax:
Practice Address - Street 1:7435 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3406
Practice Address - Country:US
Practice Address - Phone:757-772-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000OtherNONE
VA0000OtherNONE