Provider Demographics
NPI:1669581559
Name:THORNBURG, LACY EUGENE (MD)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:EUGENE
Last Name:THORNBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18 MEDICAL PARK DR
Mailing Address - Street 2:CAROLINA HAND AND SPORTS MEDICINE, PA
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-253-7521
Mailing Address - Fax:828-251-5992
Practice Address - Street 1:18 MEDICAL PARK DR
Practice Address - Street 2:CAROLINA HAND AND SPORTS MEDICINE, PA
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2493
Practice Address - Country:US
Practice Address - Phone:828-253-7521
Practice Address - Fax:828-251-5992
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9601088207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8983029Medicaid
F82869Medicare UPIN
NC2234467BMedicare PIN