Individual
RANDAL LUCAS SHELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 HIGHLAND AVE, LEWISTOWN, PA 17044-1167
(717) 248-5411
(717) 242-7581
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS010845L
PA
208M00000X
Hospitalist Physician
Primary
OS010845L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018237650007
—
PA
01
—
080180776
RAILROAD MEDICARE
PA
01
—
1007307260034
MEDICAID GROUP #
PA
01
—
120420410
DEPT OF LABOR
PA
01
—
1533687
GATEWAY (WH)
PA
01
—
172970
UNISON
PA
01
—
2198371
FIRST HEALTH
PA
01
—
25-1716306
HEALTHNET/TRICARE
PA
01
—
277524
MAMSI
PA
01
—
2890315
AETNA HMO
PA
01
—
308445
HEALTH AMERICA
PA
01
—
50045001
CAPITAL BLUECROSS (CH)
PA
01
—
50087606
CAPITAL BLUECROSS (WH)
PA
01
—
7437368
AETNA NON-HMO
PA
01
—
85320
HIGHMARK BLUESHIELD
PA
01
—
867633
MEDICARE GROUP #
PA
01
—
OS010845L
LICENSE
PA
01
—
P006022
GATEWAY (CH)
PA
Enumeration date
08/09/2005
Last updated
04/07/2025
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