Provider Demographics
NPI:1699972992
Name:LUSERO, ANANYA GUHA (MD)
Entity type:Individual
Prefix:DR
First Name:ANANYA
Middle Name:GUHA
Last Name:LUSERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1335 PHAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2334
Mailing Address - Country:US
Mailing Address - Phone:719-285-2091
Mailing Address - Fax:719-285-2092
Practice Address - Street 1:1335 PHAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2334
Practice Address - Country:US
Practice Address - Phone:719-285-2091
Practice Address - Fax:719-285-2092
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS20070322208000000X
CODR.0054382208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics