Susan Lackey, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA002163L Issued in PA

Practice address

3998 Red Lion Rd
Philadelphia, PA 19114-1436

Phone

(215) 612-3186

Fax

(215) 807-8235

NPI assigned

May 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639386931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500-6335",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191780001",
            "telephone_number": "215-807-8000",
            "fax_number": "215-807-8235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 RED LION RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191141436",
            "telephone_number": "215-612-3186",
            "fax_number": "215-807-8235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "SUSAN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA002163L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Lacey, PA-C
• Amber Elise Lachaud, MD
• Daniel Jonathan Lache, MD
• Amy Lachewitz, M.D.
• Richard Tim Lachman, MD
• Katherine Deoreo Lackritz, MD
• Dante Lacktman, PHARMD
• Melissa Lacombe, D.O.
• Claire Lacon
• Xavier Lacoste

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.