Provider Demographics
NPI:1366791733
Name:LUCAK, JEFFREY A (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:LUCAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:ALAN
Other - Last Name:LUCAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1180 BEACON ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3806
Mailing Address - Country:US
Mailing Address - Phone:781-770-4064
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON ST STE 6B
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3806
Practice Address - Country:US
Practice Address - Phone:781-770-4064
Practice Address - Fax:781-682-6157
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4464363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant