Individual
JOHN R. LUNDGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
7101 JAHNKE RD, SUITE 500, RICHMOND, VA 23225-4017
(804) 320-2751
(804) 330-3831
Mailing address
75 W LEE HWY, WARRENTON, VA 20186-2149
(610) 388-6600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00110003145
VA
363AS0400X
Surgical Physician Assistant
C5-0001388
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
10/16/2006
Last updated
07/19/2022
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