Provider Demographics
NPI:1780754481
Name:WOLF, LUCAS EDWARD (MD)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:EDWARD
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:85 HERRICK ST
Mailing Address - Street 2:BEVERLY HOSPITAL
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1790
Mailing Address - Country:US
Mailing Address - Phone:978-922-3000
Mailing Address - Fax:
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:BEVERLY HOSPITAL
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1790
Practice Address - Country:US
Practice Address - Phone:978-922-3000
Practice Address - Fax:978-356-5548
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-12-21
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Provider Licenses
StateLicense IDTaxonomies
MA150874207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3173852Medicaid
A22198Medicare PIN
MA3173852Medicaid