Provider Demographics
NPI:1811750680
Name:LUCAS, MADELINE E (PA-C)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:E
Last Name:LUCAS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4463
Mailing Address - Country:US
Mailing Address - Phone:513-853-9250
Mailing Address - Fax:513-281-1908
Practice Address - Street 1:10600 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4463
Practice Address - Country:US
Practice Address - Phone:513-853-9250
Practice Address - Fax:513-281-1908
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5238363A00000X
OH50.009355RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant