Provider Demographics
NPI:1124128111
Name:LUCAS, ELLIOTT W (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:W
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGSLEY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4604
Mailing Address - Country:US
Mailing Address - Phone:757-889-6890
Mailing Address - Fax:757-889-6893
Practice Address - Street 1:100 KINGSLEY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4604
Practice Address - Country:US
Practice Address - Phone:757-889-6890
Practice Address - Fax:757-889-6893
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD69405207V00000X
VA0101042387207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA020452B09Medicare PIN