Provider Demographics
NPI:1760679542
Name:LOCKARD, LUTHER (NCTMB)
Entity Type:Individual
Prefix:MR
First Name:LUTHER
Middle Name:
Last Name:LOCKARD
Suffix:
Gender:M
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 STOKES RD STE A7
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2915
Mailing Address - Country:US
Mailing Address - Phone:609-238-8644
Mailing Address - Fax:609-257-0071
Practice Address - Street 1:520 STOKES RD STE A7
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2915
Practice Address - Country:US
Practice Address - Phone:609-238-8644
Practice Address - Fax:609-257-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00009100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist