Provider Demographics
NPI:1750323895
Name:LUGO, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:LUGO
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 1:2 PASEO SERENO
Mailing Address - Street 2:LOS PASEOS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6469
Mailing Address - Country:US
Mailing Address - Phone:787-314-6834
Mailing Address - Fax:787-761-0608
Practice Address - Street 1:230 CALLE ELEONOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3005
Practice Address - Country:US
Practice Address - Phone:787-274-2244
Practice Address - Fax:787-754-8822
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14095207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086512Medicare ID - Type Unspecified
NJI22707Medicare UPIN