Healthcare Provider Details

I. General information

NPI: 1609946763
Provider Name (Legal Business Name): SUSANA LUGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

IV. Provider business mailing address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

V. Phone/Fax

Practice location:
  • Phone: 603-881-9311
  • Fax: 603-595-7772
Mailing address:
  • Phone: 603-881-9311
  • Fax: 603-595-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11177
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: