Provider Demographics
NPI:1891783650
Name:LUO, PIFU (MD)
Entity Type:Individual
Prefix:DR
First Name:PIFU
Middle Name:
Last Name:LUO
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 1:1555 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-368-4392
Mailing Address - Fax:585-723-7735
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-368-4392
Practice Address - Fax:585-723-7735
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35575207ZC0500X
NY242210207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA36385OtherWELLMARK BCBS
IA0439109Medicaid
IA1439109Medicaid
IA36384OtherWELLMARK BCBS
IAI12509Medicare ID - Type Unspecified
IA1439109Medicaid
NYJ400002144-BA0017Medicare PIN
IA36385OtherWELLMARK BCBS
IAI12511Medicare ID - Type Unspecified