Healthcare Provider Details

I. General information

NPI: 1023269107
Provider Name (Legal Business Name): RICHARD KEVIN LUGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 06/09/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 AF PENTAGON RM 4A870
WASHINGTON DC
20330-1907
US

IV. Provider business mailing address

1760 AF PENTAGON
WASHINGTON DC
20330-0001
US

V. Phone/Fax

Practice location:
  • Phone: 36-973-2557
  • Fax: 703-614-1663
Mailing address:
  • Phone: 36-973-2557
  • Fax: 36-141-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101244262
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101244262
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: