Provider Demographics
NPI:1972576551
Name:LUGO, MARIE CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:CARMEN
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:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-0259
Mailing Address - Country:US
Mailing Address - Phone:787-735-2445
Mailing Address - Fax:787-991-0885
Practice Address - Street 1:BOX 1379
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-735-2445
Practice Address - Fax:787-991-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR122662081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88562Medicare ID - Type Unspecified
PRG41223Medicare UPIN