Healthcare Provider Details

I. General information

NPI: 1104846880
Provider Name (Legal Business Name): JOHN H LUNDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE FLETCHER ALLEN HEALTH CARE, PATHOLOGY
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

FLETCHER ALLEN HEALTHCARE, 111 COLCHESTER AVENUE DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5135
  • Fax: 802-847-3987
Mailing address:
  • Phone: 802-847-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number042-0007305
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: