Provider Demographics
NPI:1043356868
Name:LJUNG, TOR MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:TOR
Middle Name:MARTIN
Last Name:LJUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-8824
Practice Address - Street 1:6752 PARKER FARM DR # 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3175
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-341-3321
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000000882086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126PGMedicaid
NC89126PGMedicaid