Provider Demographics
NPI:1629068630
Name:LUTHRA, JUGINDER K (MD)
Entity Type:Individual
Prefix:DR
First Name:JUGINDER
Middle Name:K
Last Name:LUTHRA
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 1:8135 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6244
Mailing Address - Country:US
Mailing Address - Phone:330-758-0900
Mailing Address - Fax:
Practice Address - Street 1:314 PENCO RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3813
Practice Address - Country:US
Practice Address - Phone:304-723-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10708207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096148000Medicaid
OH0301917Medicaid
OH0301917Medicaid
D49235Medicare UPIN
WV0418496Medicare ID - Type Unspecified