Provider Demographics
NPI:1023544210
Name:IRWIN, LUCAS WADE (DO)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:WADE
Last Name:IRWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6701
Mailing Address - Country:US
Mailing Address - Phone:814-231-7100
Mailing Address - Fax:814-238-0790
Practice Address - Street 1:1061 N FRONT ST STE 2
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8257
Practice Address - Country:US
Practice Address - Phone:814-376-6200
Practice Address - Fax:814-376-6215
Is Sole Proprietor?:No
Enumeration Date:2017-05-07
Last Update Date:2024-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS019619207Q00000X
PAOT017622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine