Provider Demographics
NPI:1871719757
Name:LUCAS, JESSICA GEIMER (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GEIMER
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 16TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-242-7751
Mailing Address - Fax:304-242-7254
Practice Address - Street 1:58 16TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:304-242-7751
Practice Address - Fax:304-242-7254
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2129207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009080Medicaid
OH2754694Medicaid
P00429155OtherRAILROAD MEDICARE
WV7374121Medicare PIN