MEDICARE: ALICIA CAMILLE LACY

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	172A00000X	Driver	29012447	PA

General Provider Information

NPI Number	:	1780405373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA CAMILLE LACY

Provider Business Mailing Address
First Line	:	2227 W MARKET ST FL 2
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-5516
Country	:	US
Telephone Number	:	717-318-1904
Fax Number	:	888-527-3213

Provider Business Practice Location Address
First Line	:	2227 W MARKET ST FL 2
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17404-5516
Country	:	US
Telephone Number	:	717-318-1904
Fax Number	:	888-527-3213

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

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “ ALICIA CAMILLE LACY ” Practice Location

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