Provider Demographics
NPI:1457344012
Name:LUCAS, JUDITH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:391 MYRTLE AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-262-5401
Mailing Address - Fax:518-262-4450
Practice Address - Street 1:391 MYRTLE AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-262-5401
Practice Address - Fax:518-262-4450
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2019-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1986462080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01585717Medicaid
NY55858TMedicare ID - Type Unspecified
NY01585717Medicaid