Provider Demographics
NPI:1174927941
Name:RAQUEL LUGO MD LLC
Entity type:Organization
Organization Name:RAQUEL LUGO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-344-0154
Mailing Address - Street 1:547 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2806
Mailing Address - Country:US
Mailing Address - Phone:860-344-0154
Mailing Address - Fax:860-344-0154
Practice Address - Street 1:547 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2806
Practice Address - Country:US
Practice Address - Phone:860-344-0154
Practice Address - Fax:860-344-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0426472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty