Healthcare Provider Details

I. General information

NPI: 1336122746
Provider Name (Legal Business Name): DOUGLAS W LUNDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 09/19/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST PPHP2
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1735
  • Fax: 866-230-6659
Mailing address:
  • Phone: 484-526-6048
  • Fax: 833-213-6428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number044778
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD475767
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: