Healthcare Provider Details

I. General information

NPI: 1265893911
Provider Name (Legal Business Name): LUNIS AND ASSIOCIATES PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE SUITE 303
BALTIMORE MD
21215-5228
US

IV. Provider business mailing address

2411 W. BELVEDERE AVE SUITE 303
BALTIMORE MD
21215-5228
US

V. Phone/Fax

Practice location:
  • Phone: 410-466-4700
  • Fax: 410-466-4746
Mailing address:
  • Phone: 410-466-4700
  • Fax: 410-466-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD21748
License Number StateMD

VIII. Authorized Official

Name: PAUL LUNIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-466-4700