Basic Information
| Provider Information | |||||||||
| NPI: | 1780601260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | WOT 12TH FLOOR ATTN PHYSICIAN SERVICES | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083685529 | ||||||||
| FaxNumber: | 5083685530 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 MAY ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083687888 | ||||||||
| FaxNumber: | 5087671290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 40857 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2053748 | 05 | MA | MEDICAID | 7827289 | 01 | AETNA US HEALTHCARE | OTHER | E18010 | 01 | MEDICARE B | OTHER | 28004 | 01 | HEALTHY START | OTHER | 784158 | 01 | MVP HEALTH CARE | OTHER | 4671499 | 01 | CIGNA HEALTH PLAN | OTHER | E18010 | 01 | BLUE CARE ELECT | OTHER | E18010 | 01 | BLUE SHIELD INDEMNITY | OTHER | 28004 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | E18010 | 01 | BLUE SHIELD HMO BLUE | OTHER | 0400877 | 01 | EVERCARE | OTHER | AA1234 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 9900077 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 1060934 | 01 | FIRST HEALTH | OTHER |