1669944146 NPI number — MS. MARGARET PEGGY LUCAS PMHNP

Table of content: MS. MARGARET PEGGY LUCAS PMHNP (NPI 1669944146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669944146 NPI number — MS. MARGARET PEGGY LUCAS PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCAS
Provider First Name:
MARGARET
Provider Middle Name:
PEGGY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OWUSU
Provider Other First Name:
MARGARET
Provider Other Middle Name:
PEGGY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669944146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12110-0704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-429-3072
Provider Business Mailing Address Fax Number:
518-785-0342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 BALLTOWN RD BLDG 12D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12304-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-388-1848
Provider Business Practice Location Address Fax Number:
518-370-7375
Provider Enumeration Date:
12/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  F402412 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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