Healthcare Provider Details

I. General information

NPI: 1003614520
Provider Name (Legal Business Name): LUCAS ONEILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3791 STATE ROUTE 2023
CLIFFORD TOWNSHIP PA
18470-7482
US

IV. Provider business mailing address

3791 STATE ROUTE 2023
CLIFFORD TOWNSHIP PA
18470-7482
US

V. Phone/Fax

Practice location:
  • Phone: 570-616-7055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberPA1034354
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: