Provider Demographics
NPI:1376860767
Name:LUNARDINI, JESSICA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:LUNARDINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MAIN ST.
Mailing Address - Street 2:FAHC/PCIM-GIVEN ESSEX
Mailing Address - City:ESSEX JCT.
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-847-8354
Mailing Address - Fax:
Practice Address - Street 1:87 MAIN ST.
Practice Address - Street 2:FAHC/PCIM-GIVEN ESSEX
Practice Address - City:ESSEX JCT.
Practice Address - State:VT
Practice Address - Zip Code:05452
Practice Address - Country:US
Practice Address - Phone:802-847-8354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0012936207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program