MEDICARE: LUCINDA KATHLEEN MCADAMS

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	2255A2300X	Athletic Trainer	103044212	SC

General Provider Information

NPI Number	:	1861186934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCINDA KATHLEEN MCADAMS

Provider Business Mailing Address
First Line	:	3510 YACHT CLUB RD
Second Line	:
City	:	EDEN
State	:	MD
Zip	:	21822-2263
Country	:	US
Telephone Number	:	843-860-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 YACHT CLUB RD
Second Line	:
City	:	EDEN
State	:	MD
Zip	:	21822-2263
Country	:	US
Telephone Number	:	843-860-0003
Fax Number	:

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

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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