Provider Demographics
NPI:1437115870
Name:LUTAS, ANEMARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANEMARIA
Middle Name:
Last Name:LUTAS
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:PO BOX 602108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2108
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:8471 RESOLUTE WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7390
Practice Address - Country:US
Practice Address - Phone:843-876-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104904207R00000X
IN01055289A207R00000X
SC38719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200399450Medicaid
IN0000007894044OtherANTHEM BLUE CROSS/BLUE SHIELD PIN
ILH75098Medicare UPIN
IN0000007894044OtherANTHEM BLUE CROSS/BLUE SHIELD PIN
INH75098Medicare UPIN