Healthcare Provider Details

I. General information

NPI: 1619755204
Provider Name (Legal Business Name): LUCAS CRAIG HAMLIN ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MINOT AVE
AUBURN ME
04210-3922
US

IV. Provider business mailing address

20 NOBLE ST APT 1
LEWISTON ME
04240-5643
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-1328
  • Fax:
Mailing address:
  • Phone: 207-322-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT958
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: