Provider Demographics
NPI:1780114512
Name:LUNIG, NICHOLAS ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ADAM
Last Name:LUNIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 CIVIC CENTER BLVD RM 55
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1910
Practice Address - Country:US
Practice Address - Phone:215-590-1220
Practice Address - Fax:978-505-5974
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD471170208000000X
PAMT212772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty