Healthcare Provider Details

I. General information

NPI: 1447413323
Provider Name (Legal Business Name): MYRO A LU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9080 BEALE RD
BETHESDA MD
20889-5633
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY MEDICAL CENTER
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-2365
  • Fax:
Mailing address:
  • Phone: 301-400-2365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number709
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: