Provider Demographics
NPI:1053379990
Name:FRUGONE LARREA, LUIGI PAOLO (MD)
Entity type:Individual
Prefix:
First Name:LUIGI
Middle Name:PAOLO
Last Name:FRUGONE LARREA
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 1:2201 S STERLING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4044
Mailing Address - Country:US
Mailing Address - Phone:828-580-6753
Mailing Address - Fax:828-580-6759
Practice Address - Street 1:2201 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4044
Practice Address - Country:US
Practice Address - Phone:828-580-6753
Practice Address - Fax:828-580-6759
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-02165207R00000X, 207R00000X
WI17849-875208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053379990Medicaid
AL51532145OtherBCBS - GOODWATER
51536600OtherBCBS - TALL.
AL009936521Medicaid
AL009939264Medicaid
AL51532352OtherBCBS - SYLACAUGA
AL540003928Medicaid
AL529927850Medicaid
AL529908510Medicaid
AL529908510Medicaid