Provider Demographics
NPI:1366426868
Name:LUJAN, GIOVANNI MARIO (MD)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:MARIO
Last Name:LUJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARIO
Other - Middle Name:GEOVANNI
Other - Last Name:LUJAN CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-5458
Mailing Address - Fax:614-293-2779
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-366-5458
Practice Address - Fax:614-293-2779
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00710207ZP0102X
OH35.086723207ZP0102X
FLME94351207ZP0102X
TXL8421207ZP0102X
UT5829457-1205207ZP0102X
SC27635207ZP0102X
LAMD.200176207ZP0102X
MDD59742207ZP0102X
GA056336207ZP0102X
IA36050207ZP0102X
OK24686207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M8258OtherBCBS
OH0386979Medicaid