Provider Demographics
NPI:1174541213
Name:LUCAS, STEFAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 JEFFERSON RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3104
Mailing Address - Country:US
Mailing Address - Phone:844-748-7242
Mailing Address - Fax:844-586-2669
Practice Address - Street 1:1240 JEFFERSON RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3104
Practice Address - Country:US
Practice Address - Phone:844-748-7242
Practice Address - Fax:844-586-2669
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229504207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0189393590OtherBLUE CHOICE GROUP
NY02501119Medicaid
NY00026573501OtherUNIVERA PROV#
NYMDH685OtherPREFERRED CARE
NY7917460OtherAETNA PROV#
NY2222OtherBLUE SHIELD GROUP
NYP010229504OtherBLUE CHOICE
NYH96984Medicare UPIN
NY7917460OtherAETNA PROV#