Healthcare Provider Details

I. General information

NPI: 1053579870
Provider Name (Legal Business Name): JEAN LUNDBERG WRIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN FRANCES LUNDBERG

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4788
  • Fax: 202-537-4964
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD76913
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: