Provider Demographics
NPI:1679553044
Name:PAVLOVICH, LUCAS JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:JOHN
Last Name:PAVLOVICH
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 1:812 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3181
Mailing Address - Country:US
Mailing Address - Phone:304-636-3300
Mailing Address - Fax:
Practice Address - Street 1:801 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3147
Practice Address - Country:US
Practice Address - Phone:304-636-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19751207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659391472OtherTYPE II NPI
WV0098428000Medicaid
WV001722346OtherBC/BS NUMBER
WV5110270001OtherMEDICARE DME
WV5110270001OtherMEDICARE DME
1659391472OtherTYPE II NPI
5110270001Medicare NSC