Provider Demographics
NPI:1225088107
Name:LUNA, MAX A (MD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:A
Last Name:LUNA
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:500 RAY C HUNT DR FL 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2981
Practice Address - Country:US
Practice Address - Phone:434-243-4520
Practice Address - Fax:434-244-4522
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200075207RC0000X
VA0101244071207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626589Medicaid
VA1225088107Medicaid
LA1626589Medicaid
LA4J811Medicare PIN