Provider Demographics
NPI:1992733505
Name:JUGINDER K LUTHRA MD INC
Entity type:Organization
Organization Name:JUGINDER K LUTHRA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUGINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LUTHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-5200
Mailing Address - Street 1:PO BOX 2481
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1681
Mailing Address - Country:US
Mailing Address - Phone:304-723-5200
Mailing Address - Fax:
Practice Address - Street 1:314 PENCO RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3813
Practice Address - Country:US
Practice Address - Phone:304-723-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10708207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096148002Medicaid
OH9293682Medicare ID - Type Unspecified
WV0096148002Medicaid
WV9293681Medicare ID - Type Unspecified
D49235Medicare UPIN