Provider Demographics
NPI:1184627747
Name:LACEY, JAMES E (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:LACEY
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:560 W MACPHAIL RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4320
Practice Address - Country:US
Practice Address - Phone:410-638-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11032500207Q00000X
PAMD444780207Q00000X
MDD0057509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA237293YEBKMedicare PIN
PA237293YUNMMedicare PIN
DC342713YWV2Medicare PIN
MD248277YVZMedicare PIN
MD248277ZDDBMedicare PIN
PA2693765OtherHIGHMARK BLUE SHIELD
PA30114483OtherAMERIHEALTH MERCY - WMG
MD4440337OtherCIGNA
MD521116591OtherCOVENTRY
MD7081362OtherAETNA
PA001912613Medicaid
MD784381000Medicaid
MD63328405OtherCAREFIRST BC/BS RENDERING
MD506026OtherNCPPO
MD521116591OtherMARYLAND PHYSICIANS
MD521116591OtherINFORMED
S135O506Medicare PIN
PA237293FLTMedicare PIN
MD521116591OtherTRICARE
MD8155693OtherOPTIMUM CHOICE/MDIPA
H68066Medicare UPIN
MD123591OtherPRIORITY PARTNERS
PA418251OtherUPMC
MDT5880037OtherCF BC/BS GRP/GHMSI/BL CHO