MEDICARE: VICTORIA M LUCAS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA7129	MA

General Provider Information

NPI Number	:	1396398251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA M LUCAS PA-C

Provider Business Mailing Address
First Line	:	29B COTTAGE ST STE B
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-1206
Country	:	US
Telephone Number	:	413-549-7400
Fax Number	:	413-549-7402

Provider Business Practice Location Address
First Line	:	29B COTTAGE ST
Second Line	:
City	:	AMHERST
State	:	MA
Zip	:	01002-1206
Country	:	US
Telephone Number	:	413-549-7400
Fax Number	:	413-549-7402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	06/16/2020

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