Provider Demographics
NPI:1336458298
Name:LUCAS, ANGELA MCCARTHY (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MCCARTHY
Last Name:LUCAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 VONDERBURG DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5968
Mailing Address - Country:US
Mailing Address - Phone:813-681-5658
Mailing Address - Fax:813-681-5250
Practice Address - Street 1:500 VONDERBURG DR STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5968
Practice Address - Country:US
Practice Address - Phone:813-681-5658
Practice Address - Fax:813-681-5250
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156701207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114664500Medicaid