Healthcare Provider Details

I. General information

NPI: 1831877992
Provider Name (Legal Business Name): MARIE ELIZABETH LUCAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MAIN ST
ONEONTA NY
13820-2507
US

IV. Provider business mailing address

25 BROAD ST APT 10D
NEW YORK NY
10004-2522
US

V. Phone/Fax

Practice location:
  • Phone: 607-433-1790
  • Fax:
Mailing address:
  • Phone: 440-954-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030844
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: