Provider Demographics
NPI:1689621765
Name:LUNNY, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LUNNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:LUNNY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1999 MOWRY AVE
Mailing Address - Street 2:SUITE R
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1738
Mailing Address - Country:US
Mailing Address - Phone:510-745-8186
Mailing Address - Fax:510-745-8332
Practice Address - Street 1:1999 MOWRY AVE
Practice Address - Street 2:SUITE R
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1738
Practice Address - Country:US
Practice Address - Phone:510-745-8186
Practice Address - Fax:510-745-8332
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69757174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697571Medicaid
CA00G697571Medicaid
CA00G697571Medicare PIN
CAF77019Medicare UPIN