Provider Demographics
NPI:1083725782
Name:SUNDIN, JOHN ALVAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALVAR
Last Name:SUNDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 HOSPITAL AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9244
Mailing Address - Country:US
Mailing Address - Phone:336-846-8939
Mailing Address - Fax:336-846-8370
Practice Address - Street 1:200 HOSPITAL AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-846-8939
Practice Address - Fax:336-846-8370
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200601912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906217Medicaid
NC809370OtherPARTNERS MC
NC7698911OtherCIGNA HEALTHCARE
NC56162OtherMEDCOST
NC144U3OtherBCBS NC
NC208394325OtherTRICARE
NC7698911OtherCIGNA HEALTHCARE
NC5906217Medicaid
NCF40861Medicare UPIN