Provider Demographics
NPI:1235176041
Name:CARLOTA, LUPO TANJUAKIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUPO
Middle Name:TANJUAKIO
Last Name:CARLOTA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9749 GREEN SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9341
Mailing Address - Country:US
Mailing Address - Phone:901-828-4795
Mailing Address - Fax:
Practice Address - Street 1:9749 GREEN SPRUCE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-9341
Practice Address - Country:US
Practice Address - Phone:901-821-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000129722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry