Provider Demographics
NPI:1932141223
Name:LUCAS, WAYNE B (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:B
Last Name:LUCAS
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 1:205 PAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3432
Practice Address - Street 1:15 REGIONAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8850
Practice Address - Country:US
Practice Address - Phone:910-295-9207
Practice Address - Fax:910-235-3432
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800618207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891136GMedicaid
NC2900487OtherEVERCARE
SCN00611OtherSC MEDICAID PROVIDER#
NC80930OtherMEDCOST PROVIDER#
NC1136GOtherBC/BS NC PROVIDER#
NCFH2000750OtherFIRSTCAROLINACARE PROV.#
NC80930OtherMEDCOST PROVIDER#
NCFH2000750OtherFIRSTCAROLINACARE PROV.#
G76856Medicare UPIN