Basic Information
| Provider Information | |||||||||
| NPI: | 1841493368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUO | ||||||||
| FirstName: | GUANGJU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 GOODMAN ST | ||||||||
| Address2: | MAIL LOCATION 0796 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135841000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 GOODMAN ST | ||||||||
| Address2: | MAIL LOCATION 0796 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135841000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 02/15/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 35-094358 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZB0001X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0104X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | 207ZC0006X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | 207ZP0105X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZC0500X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZH0000X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZI0100X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | 207ZM0300X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | 207ZP0007X | 35-094358 | OH | N | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0055547 | 05 | OH | MEDICAID | 35.094358 | 01 | OH | STATE MEDICAL BOARD | OTHER |