Provider Demographics
NPI:1902992654
Name:LUGO-CAMANN, DENISE M (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:LUGO-CAMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19116 33RD AVE W
Mailing Address - Street 2:MAIL STOP A-NO
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4706
Mailing Address - Country:US
Mailing Address - Phone:425-771-7500
Mailing Address - Fax:425-712-7905
Practice Address - Street 1:19116 33RD AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4706
Practice Address - Country:US
Practice Address - Phone:425-771-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041309207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8321275Medicaid
WAUS7404395OtherAETNA SPECIALIST PIN
WA0039593OtherLABOR AND INDUSTRIES
WA180045486OtherRAILROAD MEDICARE
WA3328LUOtherBLUE SHIELD NUMBER
WAUS7404395OtherAETNA SPECIALIST PIN
WAH71193Medicare UPIN
WAAB32945Medicare PIN