Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 188726 | NY |
N | 2080P0207X | Pediatric Hematology-Oncologist | 188726 | NY |
NPI | 1093762098 |
---|---|
Provider Name | Kenneth G Lucas |
First Address | Binghamton, NY 13905 |
Second Address | Oneonta, NY 13820-2239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 03/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012617180002 | (05) | PA |
F07520 | (02) |