Provider Demographics
NPI:1801871645
Name:VANVOORHEES, LUCY B (MD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:B
Last Name:VANVOORHEES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 OCEAN GTWY STE 5A
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9522
Mailing Address - Country:US
Mailing Address - Phone:410-213-4751
Mailing Address - Fax:
Practice Address - Street 1:12417 OCEAN GTWY STE 5A
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9522
Practice Address - Country:US
Practice Address - Phone:410-213-4751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55906207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211009100Medicaid
MDH64015GGMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL