DR. JEFFREY N LACKEY (NPI# 1548302615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548302615 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY N LACKEY |
| Credential | M.D. |
| Practice Address |
Walter Reed National Military Ctr 8901 Wisconsin Ave Bethesda MD 20889-0001 |
| Practice Telephone | 3012954551 |
| Mailing Telephone | 3012954551 |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2018-10-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
308166 | LA | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
0101242335 | VA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184600587 | Jeffrey S Lackey | Nuclear Medicine | 300 Singleton Ridge Rd, Conway, SC 29526-9142 | 2005-12-16 |
| Street Address |
WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVE |
| City | BETHESDA |
| State | MD |
| Zip Code | 20889-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932101615 | Victor S Schneider | Specialist | Walter Reed National Military Ctr, 8901 Wisconsin Ave, Bethesda, MD 20889-0001 | 2005-08-12 |
| 1457887432 | Brent Denn Nose | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2017-05-11 |
| 1508392606 | Daniel Mitsuhiro Zink | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2017-05-10 |
| 1659807964 | Donald Francis Colantonio IIi | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Ave, Bethesda, MD 20889-0001 | 2017-05-05 |
| 1033645353 | Stephanie Ajuzie | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 4494 North Palmer Road, Building 10, 1st Floor, Room 10, Bethesda, MD 20889-0001 | 2017-05-05 |
| 1649705351 | Patrick Bagley | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-5669 | 2017-05-01 |
| 1578098729 | Gina Hyun | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2017-04-25 |
| 1053846568 | Coursen Schneider | Pediatrics | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2017-04-23 |
| 1609300276 | Alex Stanley Peters | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2017-04-20 |
| 1669906236 | Yarrow Sheldon | Student in an Organized Health Care Education/Training Program | Walter Reed National Military Ctr, 8901 Wisconsin Avenue, Bethesda, MD 20889-0001 | 2017-04-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457987034 | Michael Franco | Student in an Organized Health Care Education/Training Program | Internal Medicine - Walter Reed Nmmc, 8901 Wisconsin Avenue, Bethesda, MD 20889 | 2020-03-16 |
| 1245862135 | Kay Tomashek | Pediatrics | National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889 | 2020-02-07 |
| 1104470657 | Adam Pink | Dentist | 8901 Wisconsin Ave Building 9 Floor 2, Bethesda, MD 20889 | 2019-08-01 |
| 1659939155 | Matthew Heller | Student in an Organized Health Care Education/Training Program | Psychiatry Walter Reed National Military Medica, 8901 Wisconsin Avenue, Bethesda, MD 20889 | 2019-05-30 |
| 1891258034 | Jane Ann Crotteau | Student in an Organized Health Care Education/Training Program | Pediatrics Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889 | 2019-04-12 |
| 1417434341 | Andrea Baeder | Dentist | 8901 Wisconsin Ave Bldg 9, Floor 2, Bethesda, AA 20889 | 2018-07-24 |
| 1942741723 | John Vance | Orthotist | Wrnmmc Orthotics, 8901 Wisconsin Avenue, Bethesda, MD 20889 | 2017-03-14 |
| 1790225704 | Sylvia Best | Pharmacist | 8901 Wisconsin Avenue Wrnmmc-, Americas Building 19- Internal Medicine Suite 2820, Bethesda, MD 20889 | 2017-02-24 |
| 1255783767 | Ryan Kaye | Student in an Organized Health Care Education/Training Program | Nsa Bethesda, 8901 Wisconsin Ave, Bethesda, Md 20889, Fpo, AA 20889 | 2016-07-08 |
| 1366861221 | Tara Elizabeth Brown | Internal Medicine | 8901 Wisconsin Avenue Walter Reed Nmmc, Bethesda, MD 20889 | 2014-04-08 |
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| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518480136 | Forefront Dermatology, S.c. | Dermatology | 8134 Old Georgetown Rd, Bethesda, MD 20814 | 2017-07-25 |
| 1982670980 | Andrew Denis Montemarano | Dermatology | 6410 Rockledge Drive, Suite 300, Bethesda, MD 20817-7811 | 2006-02-28 |
| 1467509620 | Luke C. Nicholas | Dermatology | 8901 Rockville Pike, Bethesda, MD 20889-0001 | 2007-01-03 |
| 1942276852 | Skin Cancer Surgery Center, LLC | Dermatology | 6410 Rockledge Dr, Suite 300, Bethesda, MD 20817-7811 | 2006-02-28 |
| 1619943644 | Mark Lawrence Welch | Dermatology | 6410 Rockledge Dr, Suite 300, Bethesda, MD 20817-1809 | 2006-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891267936 | Beckley Dermatology Inc. | Dermatology | 1110 Professional Ct Ste 201, Hagerstown, MD 21740-5945 | 2018-12-31 |
| 1407014913 | Zaineb H Makhzoumi | Dermatology | 419 West Redwood Street, Suite 260, Baltimore, MD 21201 | 2008-05-30 |
| 1003002163 | Charles County Surgical Associates, LLC | Dermatology | 4225 Altamont Pl Unit 3, White Plains, MD 20695-3063 | 2007-09-21 |
| 1164458873 | Eric Finzi | Dermatology | 7701 Greenbelt Rd, 504, Greenbelt, MD 20770-2037 | 2006-06-24 |
| 1720059736 | David S Mezebish | Dermatology | 9711 Medical Center Dr Ste 307, Rockville, MD 20850-3385 | 2006-01-28 |
| 1942282371 | Michael Rebert Warner | Dermatology | 63 Thomas Johnson Dr, Suite B, Frederick, MD 21702-4384 | 2005-11-21 |
| 1659900850 | Cronin Dermatology and Skin Cancer | Dermatology | 5530 Wisconsin Ave Ste 1418, Chevy Chase, MD 20815-4302 | 2020-04-08 |
| 1821582917 | Charles B Toner Md Pa | Dermatology | 9131 Piscataway Rd Ste 550, Clinton, MD 20735 | 2018-06-21 |
| 1689950610 | Dal Dermatology, Inc. | Dermatology | 26215 Ridge Rd, Damascus, MD 20872-1829 | 2011-10-21 |
| 1831470764 | Verghese & Ling, Md Pa | Dermatology | 26840 Point Lookout Rd, Shanti Medical Center, Leonardtown, MD 20650-1409 | 2011-09-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.