Provider Demographics
NPI:1669488375
Name:LUGO, MARIA D (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
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:ONE THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505
Mailing Address - Country:US
Mailing Address - Phone:609-298-2005
Mailing Address - Fax:609-324-8267
Practice Address - Street 1:23203 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1984
Practice Address - Country:US
Practice Address - Phone:609-303-4450
Practice Address - Fax:603-303-4451
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA08059100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141356Medicaid
NJ193836Medicare PIN
NJ0141356Medicaid