Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD073189L | PA |
NPI | 1033114467 |
---|---|
Provider Name | John P Lundin |
First Address | Scranton, PA 18510-1624 |
Second Address | Scranton, PA 18510-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91498 | (02) | PA |