Provider Demographics
NPI:1124459615
Name:LUCAS, JAMES III (RD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:LUCAS
Suffix:III
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 OLD FOXON ROAD
Mailing Address - Street 2:UNIT 30B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513
Mailing Address - Country:US
Mailing Address - Phone:203-376-8271
Mailing Address - Fax:
Practice Address - Street 1:167 OLD FOXON ROAD
Practice Address - Street 2:UNIT 30B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513
Practice Address - Country:US
Practice Address - Phone:203-376-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000985133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered