Healthcare Provider Details

I. General information

NPI: 1134969660
Provider Name (Legal Business Name): LEANA KARAM LUCAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 MAIN ST
WEST SPRINGFIELD MA
01089-3958
US

IV. Provider business mailing address

445 ADAMS ST
FALL RIVER MA
02720-4013
US

V. Phone/Fax

Practice location:
  • Phone: 413-739-6611
  • Fax:
Mailing address:
  • Phone: 774-365-1509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA100806
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: