Individual
JACK I LU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
400 W 7TH ST, FREDERICK, MD 21701
(240) 566-4722
Mailing address
400 W 7TH ST, FREDERICK, MD 21701-4506
(240) 566-4723
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101240453
VA
207R00000X
Internal Medicine Physician
Primary
D65008
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982717765
—
VA
01
—
P00417036
MEDICARE RAILROAD CARRIER
VA
Enumeration date
08/16/2006
Last updated
06/19/2018
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