Provider Demographics
NPI:1063402998
Name:LUCAS, SHANTAE LADON (MD)
Entity type:Individual
Prefix:DR
First Name:SHANTAE
Middle Name:LADON
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BRADDOCK WAY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2026
Mailing Address - Country:US
Mailing Address - Phone:828-277-1162
Mailing Address - Fax:
Practice Address - Street 1:551 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2316
Practice Address - Country:US
Practice Address - Phone:828-212-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800619207RX0202X, 207RH0003X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC36-71291OtherUNITED HEALTHCARE
NC891173AMedicaid
NC99564OtherMEDCOST
NC1173AOtherBLUE CROSS BLUE SHIELD NC
NC830005265OtherMEDICARE RAILROAD
NC36-71291OtherCIGNA
NCNC5189AMedicare PIN
NC36-71291OtherUNITED HEALTHCARE
NCF84384Medicare UPIN
NC2257815BMedicare PIN
NC891173AMedicaid
NC2257815AMedicare PIN