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Individual

DR. THOMAS A. LACY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11715 ORPINGTON STREET, SUITE A, TLC PEDIATRICS AND ADOLESCENT MEDICINE IN ASSOC WITH NE, ORLANDO, FL 32817-4600
(407) 380-9115
(407) 380-9189
Mailing address
P.O. BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-4488
(302) 651-4945

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME58227
FL
208D00000X
General Practice Physician
Primary
ME58227
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
063917600
FL
01
1103520
UNITED HEALTHCARE
FL
01
11452
BCBS
FL
01
201529976
BEECHSTREET
FL
01
257675
USA MANAGED CARE NETWORK
FL
01
270015
AMERIGROUP
FL
01
4006175
AETNA HEALTHCARE
FL
01
4828516
CIGNA HEALTHCARE
FL
01
FAO23
FHHS
FL
Enumeration date
07/18/2006
Last updated
12/07/2012
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