Provider Demographics
NPI:1245524479
Name:LUNDEBERG, MEGAN ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ROSE
Last Name:LUNDEBERG
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 1:501 N GRAHAM ST STE 580
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-2003
Mailing Address - Country:US
Mailing Address - Phone:503-528-0704
Mailing Address - Fax:503-528-0708
Practice Address - Street 1:501 N GRAHAM ST STE 580
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2003
Practice Address - Country:US
Practice Address - Phone:503-528-0704
Practice Address - Fax:503-528-0708
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1847112086S0102X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program