=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023030459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN R. LUCAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2006
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1017 ASHES DR SUITE 206
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28405-8308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-239-9584
-----------------------------------------------------
Fax | 910-679-4086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 603725
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-3725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-575-2625
-----------------------------------------------------
Fax | 828-350-2174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 2007-01120
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------