Provider Demographics
NPI:1215905724
Name:LUCKS, MATTHEW ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
Last Name:LUCKS
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 1:700 S WASHINGTON ST STE 330
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4252
Mailing Address - Country:US
Mailing Address - Phone:703-717-7780
Mailing Address - Fax:703-717-7781
Practice Address - Street 1:700 S WASHINGTON ST STE 330
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314
Practice Address - Country:US
Practice Address - Phone:703-717-7780
Practice Address - Fax:703-717-7781
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264632207RC0000X
CAA91447207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A914470Medicaid
WA81447AMedicare PIN