Provider Demographics
NPI:1184820292
Name:MCGAHA, QING LU (MD)
Entity type:Individual
Prefix:DR
First Name:QING
Middle Name:LU
Last Name:MCGAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:QING
Other - Middle Name:
Other - Last Name:LU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 N MCMULLEN BOOTH RD STE C4
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2129
Mailing Address - Country:US
Mailing Address - Phone:727-799-0464
Mailing Address - Fax:727-286-8970
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD STE C4
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2129
Practice Address - Country:US
Practice Address - Phone:727-799-0464
Practice Address - Fax:727-286-8970
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98949208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279502700Medicaid
FL16024OtherBCBS
FLAH684ZMedicare PIN