Basic Information
| Provider Information | |||||||||
| NPI: | 1609851583 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACY | ||||||||
| FirstName: | HILTON | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 OLD LYNCHBURG RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229036550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349701543 | ||||||||
| FaxNumber: | 4349721831 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 OLD LYNCHBURG RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229036500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349721800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 05/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0101047662 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | 0101047662 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 088531 | 01 | VA | SENTARA | OTHER | 378228 | 01 | VA | MAMSI | OTHER | 7118716 | 05 | VA | MEDICAID | 2011654 | 01 | VA | CIGNA | OTHER | VV7295A | 01 | VA | MEDICARE PTAN | OTHER | 206019 | 01 | VA | MANAGED HEALTH NETWORK | OTHER | 255060000 | 01 | VA | MAGELLAN | OTHER | 236368 | 01 | VA | ANTHEM BCBS | OTHER | 249648 | 01 | VA | VALUE OPTIONS | OTHER | 604718 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 504967 | 01 | VA | PRIVATE HEALTHCARE SYSTEM | OTHER | 7134107 | 01 | VA | AETNA | OTHER |