Provider Demographics
NPI:1336343516
Name:LUGO, NELSON (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:LUGO SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:43330 JUNCTION PLZ STE 160
Mailing Address - Street 2:PMB 108
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3408
Mailing Address - Country:US
Mailing Address - Phone:703-943-0956
Mailing Address - Fax:484-737-4683
Practice Address - Street 1:43330 JUNCTION PLZ STE 160
Practice Address - Street 2:PMB 108
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3408
Practice Address - Country:US
Practice Address - Phone:703-943-0956
Practice Address - Fax:484-737-4683
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1798362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBL2297340OtherDEA
NYBL2297340OtherDEA
HI0000BDYNQMedicare ID - Type Unspecified