Provider Demographics
NPI:1427101146
Name:LUNDGREN, LAURA M (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:200 CLEAVER FARM RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1630
Practice Address - Country:US
Practice Address - Phone:302-633-6338
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2013-02-05
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Provider Licenses
StateLicense IDTaxonomies
DEC1-000804.208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEC1-0008043OtherPROFESSIONAL LICENSE