Basic Information
Provider Information | |||||||||
NPI: | 1962499897 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LU | ||||||||
FirstName: | HUA | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 50 MAUDE ST | ||||||||
Address2: |   | ||||||||
City: | PROVIDENCE | ||||||||
State: | RI | ||||||||
PostalCode: | 029084325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014565368 | ||||||||
FaxNumber: | 4014562684 | ||||||||
Practice Location | |||||||||
Address1: | 6 BLACKSTONE VALLEY PL | ||||||||
Address2: | SUITE 502 | ||||||||
City: | LINCOLN | ||||||||
State: | RI | ||||||||
PostalCode: | 028651179 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4013346250 | ||||||||
FaxNumber: | 4013346262 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/05/2005 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD09946 | RI | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD81257 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 9002864 | 05 | RI |   | MEDICAID |