Provider Demographics
NPI:1528282530
Name:LANCASTER, ANGELICA P (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:P
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:P
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6244
Mailing Address - Country:US
Mailing Address - Phone:512-462-3627
Mailing Address - Fax:512-462-3431
Practice Address - Street 1:800 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6244
Practice Address - Country:US
Practice Address - Phone:512-462-3627
Practice Address - Fax:512-462-3431
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U73UMedicare ID - Type UnspecifiedMEDICARE GROUP
TX8C7271Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL