MEDICARE: LUCAS POLITO 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	021301	NY

General Provider Information

NPI Number	:	1124547823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS POLITO PA-C

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:
Fax Number	:	585-922-1011

Provider Business Practice Location Address
First Line	:	1425 PORTLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3095
Country	:	US
Telephone Number	:	585-922-4371
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	06/05/2026

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