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Contact Information

DARYL B LUNDGRIN, MD
5301 VIRGINIA WAY
SUITE 300
BRENTWOOD, TN37027-7541
 Phone: 615-221-4474
 Fax: 615-234-3774
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
 

Anatomic Pathology

207ZP0101X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for DARYL B LUNDGRIN · (Male)

NPI # 1881682813
Status Active
Credentials MD
Entity Individual
Enumeration date 10/13/2005
Last updated 10/28/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • KY License # 43153
  • TN License # MD25297
  • GA Medicaid 00623235A
  • NC Medicaid 89063XK
  • TN Medicaid 3383335
  • Other 264946 BLACK LUNG
  • Other TN0101 JOHN DEER
  • Other 100022075 PHP OF TN
  • Other 220018743 RAILROAD MEDICARE
  • Other PAYSUB TRIGON
  • Other 1140001 UNITED HEALTHCARE
  • TN Other 3031330 BCBS OF TN
Hospital affiliation(s)
  • GREENVIEW REGIONAL HOSPITAL - (Acute Care)
    1801 ASHLEY CIRCLE
    BOWLING GREEN, KY 42104
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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