Provider Demographics
NPI:1841250982
Name:KATHLEEN E. LUCAS MD, PA
Entity type:Organization
Organization Name:KATHLEEN E. LUCAS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-510-5510
Mailing Address - Street 1:1416 YANCEYVILLE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6955
Mailing Address - Country:US
Mailing Address - Phone:336-510-5510
Mailing Address - Fax:336-510-5515
Practice Address - Street 1:1416 YANCEYVILLE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6955
Practice Address - Country:US
Practice Address - Phone:336-510-5510
Practice Address - Fax:336-510-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790238LMedicaid
NCB9751OtherMEDCOST INSURANCE
NC1200895OtherUNITED HEALTHCARE
NC1207825OtherUNITED HEALTHCARE
NC7560128OtherAETNA INSURANCE
NC87515OtherMEDCOST INSURANCE
NC2468828OtherUNITED HEALTHCARE
NC013VVOtherBLUE CROSS OF NC
NC7500692OtherAETNA INSURANCE
NCE0113OtherMEDCOST INSURANCE
NC4238847OtherAETNA INSURANCE
NC5900891OtherAETNA INSURANCE
NC1201591OtherUNITED HEALTHCARE
NC34585OtherMEDCOST INSURANCE
NC1207825OtherUNITED HEALTHCARE
NC790238LMedicaid
NC013VVOtherBLUE CROSS OF NC
NCB9751OtherMEDCOST INSURANCE