Healthcare Provider Details

I. General information

NPI: 1992149025
Provider Name (Legal Business Name): LUCAS S MARCHAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST FL 3
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

1211 S CONKLING ST APT 456
BALTIMORE MD
21224-5348
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-8007
  • Fax:
Mailing address:
  • Phone: 208-221-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9169383-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: