Provider Demographics
NPI:1154372514
Name:LUCAS, ROBERT GENE (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GENE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LAMB CIR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6344
Mailing Address - Country:US
Mailing Address - Phone:540-731-2866
Mailing Address - Fax:540-731-2867
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-731-2866
Practice Address - Fax:540-731-2867
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003733363A00000X
UT4942752-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806700200Medicaid
MT4301674Medicaid
QM0000069126OtherALTIUS #
12479OtherUNIVERSITY HEALTH PLANS #
74004OtherPEHP #