MEDICARE: KEVIN P LANCASTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA04768	TX
2	363AS0400X	Surgical Physician Assistant	PA04768	TX
3	363A00000X	Physician Assistant		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114956604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN P LANCASTER PA-C

Provider Business Mailing Address
First Line	:	4601 PARK RD
Second Line	:	STE. 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3239
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10496 KATY FWY
Second Line	:	#101
City	:	HOUSTON
State	:	TX
Zip	:	77043-5106
Country	:	US
Telephone Number	:	346-571-7500
Fax Number	:	713-492-2440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	04/12/2017

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Directions to “ KEVIN P LANCASTER PA-C” Practice Location

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