Provider Demographics
NPI:1609946763
Name:LUGO, SUSANA (MD)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:LUGO
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 1:29 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-4068
Mailing Address - Country:US
Mailing Address - Phone:603-881-9311
Mailing Address - Fax:603-595-7772
Practice Address - Street 1:29 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-4068
Practice Address - Country:US
Practice Address - Phone:603-881-9311
Practice Address - Fax:603-595-7772
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH111772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205414Medicaid
NHRE6296Medicare ID - Type UnspecifiedMEDICARE
NH30205414Medicaid