Healthcare Provider Details

I. General information

NPI: 1841250982
Provider Name (Legal Business Name): KATHLEEN E. LUCAS MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 YANCEYVILLE ST SUITE 1
GREENSBORO NC
27405-6955
US

IV. Provider business mailing address

1416 YANCEYVILLE ST SUITE 1
GREENSBORO NC
27405-6955
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-5510
  • Fax: 336-510-5515
Mailing address:
  • Phone: 336-510-5510
  • Fax: 336-510-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31329
License Number StateNC

VIII. Authorized Official

Name: KATHLEEN E. LUCAS
Title or Position: OWNER
Credential: MD
Phone: 336-510-5510