Provider Demographics
NPI: | 1164576872 |
---|---|
Name: | DUNHAM, ROZY (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ROZY |
Middle Name: | |
Last Name: | DUNHAM |
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: | 301 LIPPINCOTT DR STE 410 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARLTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08053-4197 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-355-0340 |
Mailing Address - Fax: | 856-355-0330 |
Practice Address - Street 1: | 1 BRACE RD STE C1 |
Practice Address - Street 2: | |
Practice Address - City: | CHERRY HILL |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08034-2600 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-428-4100 |
Practice Address - Fax: | 856-428-5748 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-22 |
Last Update Date: | 2021-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA08168400 | 207RC0000X, 207UN0901X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0136859 | Medicaid | |
NJ | 109884 | Medicare PIN | |
NJ | I71966 | Medicare UPIN |