MEDICARE: ELLEN LU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	MD463004	PA
2	207K00000X	Allergy & Immunology Physician	E4022	AR
3	207K00000X	Allergy & Immunology Physician	MD463004	PA

General Provider Information

NPI Number	:	1225039712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN LU MD

Provider Business Mailing Address
First Line	:	PO BOX 603725
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3725
Country	:	US
Telephone Number	:	828-575-2625
Fax Number	:	828-350-2174

Provider Business Practice Location Address
First Line	:	4212 OLD WILLIAM PENN HWY
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-1901
Country	:	US
Telephone Number	:	724-837-4070
Fax Number	:	724-837-3316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/12/2025

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Directions to “ ELLEN LU MD” Practice Location

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