Provider Demographics
NPI:1063457372
Name:AMPEY, LUTHER LORENZO III (MD)
Entity Type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:LORENZO
Last Name:AMPEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18105 PRINCE PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1514
Mailing Address - Country:US
Mailing Address - Phone:301-260-3700
Mailing Address - Fax:301-260-3710
Practice Address - Street 1:18105 PRINCE PHILIP DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1514
Practice Address - Country:US
Practice Address - Phone:301-260-3700
Practice Address - Fax:301-260-3710
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD549212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD905701300Medicaid
MDB006Medicare PIN
DC920006339Medicare PIN
MD905701300Medicaid
DC007465U99Medicare PIN
MD920006170Medicare PIN