Provider Demographics
NPI:1336314434
Name:LUGLIANI, MATTHEW R (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:R
Last Name:LUGLIANI
Suffix:
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 1:1390 S POTOMAC ST STE 136
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4529
Mailing Address - Country:US
Mailing Address - Phone:303-214-0000
Mailing Address - Fax:303-214-0335
Practice Address - Street 1:1390 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6165
Practice Address - Country:US
Practice Address - Phone:303-214-0000
Practice Address - Fax:303-214-0335
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2020-03-20
Deactivation Date:2020-03-05
Deactivation Code:
Reactivation Date:2020-03-20
Provider Licenses
StateLicense IDTaxonomies
CO440742083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82-0676791OtherOCCUPATIONAL MEDICINE