Provider Demographics
NPI:1265893911
Name:LUNIS AND ASSIOCIATES PEDIATRICS
Entity type:Organization
Organization Name:LUNIS AND ASSIOCIATES PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-466-4700
Mailing Address - Street 1:2411 W. BELVEDERE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5228
Mailing Address - Country:US
Mailing Address - Phone:410-466-4700
Mailing Address - Fax:410-466-4746
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-466-4700
Practice Address - Fax:410-466-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21748208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD787411100Medicaid