Provider Demographics
NPI:1760029557
Name:BRIDGEMAN, LUCAS DAVID (CNIM)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:DAVID
Last Name:BRIDGEMAN
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 STONELEDGE DR APT 11
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-3519
Mailing Address - Country:US
Mailing Address - Phone:518-339-6027
Mailing Address - Fax:
Practice Address - Street 1:13 STONELEDGE DR APT 11
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-3519
Practice Address - Country:US
Practice Address - Phone:518-339-6027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty