Provider Demographics
NPI:1700875150
Name:LU, DENNIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:C
Last Name:LU
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 1:450 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1755
Mailing Address - Country:US
Mailing Address - Phone:518-566-2020
Mailing Address - Fax:581-561-5390
Practice Address - Street 1:450 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1755
Practice Address - Country:US
Practice Address - Phone:518-566-2020
Practice Address - Fax:581-561-5390
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY514B31OtherEMPIRE BLUE CROSS
2189111OtherLICENSE
2189117OtherWC
NY00415370001OtherBLUE SHIELD OF NORTHEASTE
NY02678724Medicaid
107286OtherBC UTICA
107286OtherBC UTICA
H81060Medicare UPIN
NY514B31OtherEMPIRE BLUE CROSS
107286OtherBC UTICA