Provider Demographics
NPI:1952318362
Name:LU, QING (MD, PHD)
Entity Type:Individual
Prefix:
First Name:QING
Middle Name:
Last Name:LU
Suffix:
Gender:M
Credentials:MD, PHD
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 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-2018
Mailing Address - Fax:859-301-2073
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2018
Practice Address - Fax:859-301-2073
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31751207ZP0102X
IN01085702A207ZP0101X
KY40736207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100041000Medicaid
IN200938550Medicaid
OH2853756Medicaid
KY7100041000Medicaid
KY0969433Medicare PIN
P00603532Medicare PIN
KY00415010Medicare PIN