Provider Demographics
NPI:1790065456
Name:IRVING A. LUGO, M.D., P.A.
Entity Type:Organization
Organization Name:IRVING A. LUGO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-288-6440
Mailing Address - Street 1:2311 W CONE BLVD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4042
Mailing Address - Country:US
Mailing Address - Phone:336-288-6440
Mailing Address - Fax:
Practice Address - Street 1:2311 W CONE BLVD
Practice Address - Street 2:SUITE 235
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4042
Practice Address - Country:US
Practice Address - Phone:336-288-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC308352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB5708OtherMEDCOST
NC8953174Medicaid
NC53174OtherBCBSNC
NC79578OtherCIGNA
NC4136199OtherAETNA
NCA296Medicare PIN