Provider Demographics
NPI:1902369176
Name:LU, AMANDA JING (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JING
Last Name:LU
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:JING
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD/PHD
Mailing Address - Street 1:555 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2824
Mailing Address - Country:US
Mailing Address - Phone:609-943-8453
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST # B-428
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6106
Practice Address - Country:US
Practice Address - Phone:617-278-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291506207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine