Basic Information
| Provider Information | |||||||||
| NPI: | 1841250982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KATHLEEN E. LUCAS MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1416 YANCEYVILLE ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274056955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365105510 | ||||||||
| FaxNumber: | 3365105515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1416 YANCEYVILLE ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274056955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365105510 | ||||||||
| FaxNumber: | 3365105515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LUCAS | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3365105510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 31329 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 790238L | 05 | NC | MEDICAID | B9751 | 01 | NC | MEDCOST INSURANCE | OTHER | 1200895 | 01 | NC | UNITED HEALTHCARE | OTHER | 1207825 | 01 | NC | UNITED HEALTHCARE | OTHER | 7560128 | 01 | NC | AETNA INSURANCE | OTHER | 87515 | 01 | NC | MEDCOST INSURANCE | OTHER | 2468828 | 01 | NC | UNITED HEALTHCARE | OTHER | 013VV | 01 | NC | BLUE CROSS OF NC | OTHER | 7500692 | 01 | NC | AETNA INSURANCE | OTHER | E0113 | 01 | NC | MEDCOST INSURANCE | OTHER | 4238847 | 01 | NC | AETNA INSURANCE | OTHER | 5900891 | 01 | NC | AETNA INSURANCE | OTHER | 1201591 | 01 | NC | UNITED HEALTHCARE | OTHER | 34585 | 01 | NC | MEDCOST INSURANCE | OTHER |