Provider Demographics
NPI:1083647721
Name:BUGLISI, LUCILLE A (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:A
Last Name:BUGLISI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 HARGETT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5924
Mailing Address - Country:US
Mailing Address - Phone:910-238-2485
Mailing Address - Fax:910-238-2495
Practice Address - Street 1:1021 HARGETT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5924
Practice Address - Country:US
Practice Address - Phone:910-238-2485
Practice Address - Fax:910-238-2495
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G54954Medicare UPIN