Healthcare Provider Details

I. General information

NPI: 1053152314
Provider Name (Legal Business Name): LU PLASTIC AND RECONSTRUCTIVE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 EASTGATE DR STE 200
CARLISLE PA
17015-6962
US

IV. Provider business mailing address

41 EASTGATE DR STE 200
CARLISLE PA
17015-6962
US

V. Phone/Fax

Practice location:
  • Phone: 717-316-8322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN LU
Title or Position: OWNER
Credential:
Phone: 717-316-8322