Provider Demographics
NPI:1184734477
Name:KNAPP, LUCINDA J (DO)
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:J
Last Name:KNAPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 E HOME RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2726
Mailing Address - Country:US
Mailing Address - Phone:937-398-0051
Mailing Address - Fax:937-398-0054
Practice Address - Street 1:1176 E HOME RD
Practice Address - Street 2:SUITE O
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2726
Practice Address - Country:US
Practice Address - Phone:937-398-0051
Practice Address - Fax:937-398-0054
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH80195003OtherRAILROAD MEDICARE
OH0827707Medicaid
OH000000216518OtherANTHEM
F04096Medicare UPIN
OH0699207Medicare ID - Type Unspecified