Provider Demographics
NPI:1780601260
Name:LUCAS, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT 12TH FLOOR ATTN PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:191 MAY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-368-7888
Practice Address - Fax:508-767-1290
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA40857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2053748Medicaid
7827289OtherAETNA US HEALTHCARE
E18010OtherMEDICARE B
28004OtherHEALTHY START
784158OtherMVP HEALTH CARE
4671499OtherCIGNA HEALTH PLAN
E18010OtherBLUE CARE ELECT
E18010OtherBLUE SHIELD INDEMNITY
28004OtherCHILDRENS MEDICAL SECURIT
E18010OtherBLUE SHIELD HMO BLUE
0400877OtherEVERCARE
AA1234OtherHARVARD PILGRIM HEALTHCAR
9900077OtherFALLON COMMUNITY HEALTH P
1060934OtherFIRST HEALTH
28004OtherHEALTHY START
9900077OtherFALLON COMMUNITY HEALTH P