Provider Demographics
NPI:1497782023
Name:LO, ERIC LUP SING (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LUP SING
Last Name:LO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 SWORDFISH LN
Mailing Address - Street 2:NONE
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141
Mailing Address - Country:US
Mailing Address - Phone:386-589-7980
Mailing Address - Fax:
Practice Address - Street 1:710 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4522
Practice Address - Country:US
Practice Address - Phone:910-304-1212
Practice Address - Fax:910-292-2627
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21989207RI0011X
NC2019-00745207RI0011X
WI75651207RI0011X
FLME0072993207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2019-00745OtherNORTH CAROLINA STATE LICENSE
KYPENDINGMedicaid