Provider Demographics
NPI:1215039177
Name:LUNDQUIST, THOMAS GEORGE (MD, MMM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:MD, MMM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3651
Mailing Address - Country:US
Mailing Address - Phone:724-941-5968
Mailing Address - Fax:
Practice Address - Street 1:101 MARLBORO DR
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3651
Practice Address - Country:US
Practice Address - Phone:724-941-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051840-L2080A0000X
MDD00635452080A0000X
NMMD2006-01562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine