Individual
DR. MARY LYN T LU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, FACS
Contact information
Practice address
126 TRIVETTE DR, SUITE 201, PIKEVILLE, KY 41501-1275
(606) 432-0061
(606) 432-0095
Mailing address
PO BOX 2257, PIKEVILLE, KY 41502-2257
(606) 432-0061
(606) 432-0095
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
25642
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000051790
BC/BS
KY
01
—
0114191000
WV MEDICAID
KY
01
—
1532903
UMWA
KY
01
—
240005992
R/R MEDICARE
KY
05
—
64256423
—
KY
Enumeration date
10/12/2005
Last updated
07/15/2010
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