1407842727 NPI number — DR. PAULA A LUNDGREN MD

Table of content: DR. PAULA A LUNDGREN MD (NPI 1407842727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407842727 NPI number — DR. PAULA A LUNDGREN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNDGREN
Provider First Name:
PAULA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407842727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2995 DREW ST FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33759-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-532-1355
Provider Business Mailing Address Fax Number:
813-635-2613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2102 TRINITY OAKS BLVD # 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-462-2131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD067425L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: ME147205 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 2012-01374 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: ME147205 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020051708 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017520280003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109276100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5921261 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109276100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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