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Individual

DR. LUCAS GEORGANDELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1 VINE ST, GALLIPOLIS, OH 45631-1027
(740) 645-4237
Mailing address
1 VINE ST, GALLIPOLIS, OH 45631-1027
(740) 645-4237

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21526
WV
207R00000X
Internal Medicine Physician
Primary
35-08-2167
OH
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
21526
WV
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
35-08-2167
OH
207RN0300X
Nephrology Physician
21526
WV
207RN0300X
Nephrology Physician
35-08-2167
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000185210
UNISON MEDICAID
OH
01
000000272527
ANTHEM BCBS
01
001714146
MOUNTAIN STATE BCBS
01
1730132580
NPI
05
2004717000
WV
01
2400708
MOLINA MEDICAID
OH
01
268597383-00
OH BUREAU WORKERS COMP
OH
01
310917085118
CARESOURCE MEDICAID
OH
01
P00006241
RR MEDICARE
Enumeration date
05/19/2006
Last updated
08/14/2013
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