Provider Demographics
NPI:1457356636
Name:LJUNG, MARTHA LEE (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LEE
Last Name:LJUNG
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 1:3710 SHIPYARD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-452-1400
Mailing Address - Fax:910-332-1072
Practice Address - Street 1:3710 SHIPYARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-452-1400
Practice Address - Fax:910-332-1072
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36379207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC52339OtherBCBS
NC8952339Medicaid
NC01-28704OtherUNITED HEALTHCARE
NC930085802OtherRAILROAD MEDICARE
NCB4547OtherMEDCOST
NC930086667OtherRAILROAD MEDICARE
SCQ36379Medicaid
NC930086667OtherRAILROAD MEDICARE
F51953Medicare UPIN
NC01-28704OtherUNITED HEALTHCARE
NC2183491EMedicare PIN