Provider Demographics
NPI:1821536871
Name:CARTER, LUCAS JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:JAMES
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:260 CREST RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9503
Mailing Address - Country:US
Mailing Address - Phone:802-524-8911
Mailing Address - Fax:802-524-1265
Practice Address - Street 1:260 CREST RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9503
Practice Address - Country:US
Practice Address - Phone:802-524-8911
Practice Address - Fax:802-524-1265
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT055-0031332363A00000X
VT363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant