Healthcare Provider Details

I. General information

NPI: 1295277598
Provider Name (Legal Business Name): DIANE LU MMS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 MASSACHUSETTS AVE STE 103
NORTH ANDOVER MA
01845-4143
US

IV. Provider business mailing address

1200 ELM ST UNIT 910
MANCHESTER NH
03101-2534
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number020338
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: