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NPI Code Detail

MEDICARE: DR. LUCAS JOHN PAVLOVICH MD

MEDICARE: DR. LUCAS JOHN PAVLOVICH MD
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
1207X00000XOrthopaedic Surgery Physician19751WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
45110270001OTHERWVMEDICARE DME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11659391472OTHERTYPE II NPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3001722346OTHERWVBC/BS NUMBER

General Provider Information

NPI Number : 1679553044
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUCAS JOHN PAVLOVICH MD
Provider Business Mailing Address
First Line : 812 GORMAN AVE
Second Line :
City : ELKINS
State : WV
Zip : 26241-3181
Country : US
Telephone Number : 304-636-3300
Fax Number :
Provider Business Practice Location Address
First Line : 801 GORMAN AVE
Second Line :
City : ELKINS
State : WV
Zip : 26241-3147
Country : US
Telephone Number : 304-636-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 10/02/2024

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Directions to “ DR. LUCAS JOHN PAVLOVICH MD” Practice Location

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