Provider Demographics
NPI:1679535363
Name:LUNEY, DEREK JOHN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:JOHN EDWARD
Last Name:LUNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3521 GRAYSTONE PL SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8201
Mailing Address - Country:US
Mailing Address - Phone:828-326-2354
Mailing Address - Fax:828-326-2385
Practice Address - Street 1:3521 GRAYSTONE PL SE
Practice Address - Street 2:SUITE 202
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-326-2354
Practice Address - Fax:828-326-2385
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601661207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1002COtherBCBS OF NC PROVIDER ID#
NC891002CMedicaid
NC1002COtherBCBS OF NC PROVIDER ID#
NCE20818Medicare UPIN
NC2232928BMedicare PIN