Provider Demographics
NPI:1760466841
Name:LUNDIE, DONALD WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:LUNDIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-1715
Mailing Address - Country:US
Mailing Address - Phone:757-365-8028
Mailing Address - Fax:757-356-9451
Practice Address - Street 1:919 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-1715
Practice Address - Country:US
Practice Address - Phone:757-365-8028
Practice Address - Fax:757-356-9451
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA41003OtherOPTIMA HEALTH PROVIDER NO
VA381157OtherANTHEM PROVIDER NUMBER
VA5663016Medicaid
VA5663016Medicaid
VAB08585Medicare UPIN