Provider Demographics
NPI:1578669115
Name:HUNTER, LOURDES BRIGIDA (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:BRIGIDA
Last Name:HUNTER
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 1:170 THOMAS JOHNSON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-6201
Mailing Address - Country:US
Mailing Address - Phone:301-360-0776
Mailing Address - Fax:301-631-8443
Practice Address - Street 1:170 THOMAS JOHNSON DR STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-6201
Practice Address - Country:US
Practice Address - Phone:301-360-0776
Practice Address - Fax:301-631-8443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062957207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD140P344GMedicare ID - Type Unspecified
H63574Medicare UPIN