Provider Demographics
NPI:1336771930
Name:LUCKEN, ISAAC (PA-C)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:LUCKEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:35 STOREY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1878
Practice Address - Country:US
Practice Address - Phone:978-225-6607
Practice Address - Fax:978-225-6609
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2023-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA7456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant