Provider Demographics
NPI:1982600151
Name:LUCAS, KATHLEEN E (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:LUCAS
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 1:1416 YANCEYVILLE ST
Mailing Address - Street 2:STE 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:STE 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34585OtherMEDCOST
NC4238847OtherAETNA
NC5316OtherBLUE CROSS
NC1201591OtherUNITED HEALTHCARE
NC8953161Medicaid
NC4238847OtherAETNA