Provider Demographics
NPI:1487613600
Name:PARKER-LUNDGREN, KATHLEEN P (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:PARKER-LUNDGREN
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 1:1500 N BEAUREGARD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1723
Mailing Address - Country:US
Mailing Address - Phone:703-436-1215
Mailing Address - Fax:703-499-9670
Practice Address - Street 1:1500 N BEAUREGARD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1723
Practice Address - Country:US
Practice Address - Phone:703-436-1215
Practice Address - Fax:703-488-9670
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011226875208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics