Basic Information
Provider Information | |||||||||
NPI: | 1215915418 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LUNSFORD | ||||||||
FirstName: | TERRI | ||||||||
MiddleName: | H. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOLMES | ||||||||
OtherFirstName: | TERRI | ||||||||
OtherMiddleName: | R. | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1930 CANONCHET CT | ||||||||
Address2: |   | ||||||||
City: | HANOVER | ||||||||
State: | MD | ||||||||
PostalCode: | 210761251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4105512099 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2041 GEORGIA AVE NW | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200600001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2028651121 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/06/2006 | ||||||||
LastUpdateDate: | 04/06/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0058877 | MD | N |   | Other Service Providers | Specialist |   | 207P00000X | MD32735 | DC | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
No ID Information.