Provider Demographics
NPI:1215918248
Name:MORAES-FINGLASS, LACYONI (MD)
Entity type:Individual
Prefix:DR
First Name:LACYONI
Middle Name:
Last Name:MORAES-FINGLASS
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 1:19332 TRIPLE CROWN DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-6752
Mailing Address - Country:US
Mailing Address - Phone:276-676-3969
Mailing Address - Fax:
Practice Address - Street 1:1237 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4705
Practice Address - Country:US
Practice Address - Phone:276-676-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225620207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4653146OtherAETNA
VA2108605OtherMAMSI
VAP00055669OtherRR MEDICARE
VA010003709Medicaid
VA237991OtherSOUTHERN HEALTH
VA010166700OtherBLACK LUNG
VA461931OtherANTHEM
VAE90347Medicare UPIN
VA2108605OtherMAMSI