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General NPI Number Information
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NPI Number | 1841250982
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Entity Type | Organization
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Legal Business Name | KATHLEEN E. LUCAS MD, PA
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1416 YANCEYVILLE ST SUITE 1
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City | GREENSBORO
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State | NC
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Zip | 27405-6955
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Country | US
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Telephone | 336-510-5510
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Fax | 336-510-5515
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Provider Business Mailing Address
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Address Line | 1416 YANCEYVILLE ST SUITE 1
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City | GREENSBORO
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State | NC
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Zip | 27405-6955
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Country | US
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Telephone | 336-510-5510
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Fax | 336-510-5515
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN E. LUCAS
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Credential | MD
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Telephone | 336-510-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31329
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License Number State | NC
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