Healthcare Provider Details

I. General information

NPI: 1134212798
Provider Name (Legal Business Name): CYNTHIA M. LUCAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DRIVE STE 308
SPRINGFIELD MA
01107-1270
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7020
  • Fax: 413-794-2670
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2141
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: