Provider Demographics
NPI:1881155414
Name:FELIPE BASTOS HORTA, LUCAS (MD)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:
Last Name:FELIPE BASTOS HORTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ALBANY STREET, SHAPIRO PRIMARY CARE
Mailing Address - Street 2:PRECEPTING ROOM
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128
Mailing Address - Country:US
Mailing Address - Phone:617-414-5951
Mailing Address - Fax:617-414-9251
Practice Address - Street 1:725 ALBANY STREET, SHAPIRO PRIMARY CARE
Practice Address - Street 2:PRECEPTING ROOM
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9251
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-03-27
Deactivation Date:2019-11-04
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA962532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program