Provider Demographics
NPI:1689901324
Name:LUNDHOLM, AMY LEE (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEE
Last Name:LUNDHOLM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MORTON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078
Mailing Address - Country:US
Mailing Address - Phone:610-521-1701
Mailing Address - Fax:610-521-9450
Practice Address - Street 1:8 MORTON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078
Practice Address - Country:US
Practice Address - Phone:610-521-1701
Practice Address - Fax:610-521-9450
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012979207R00000X
PAOS016883207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine