Provider Demographics
NPI:1336123074
Name:DUNTEMANN, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:DUNTEMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5818 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-483-6100
Mailing Address - Fax:757-483-2203
Practice Address - Street 1:5818 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-483-6100
Practice Address - Fax:757-483-2203
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2010-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053921207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
541870984028OtherCIGNA
C13214OtherMEDICARE RR GROUP
0058201504OtherMEDICAID FIRST HEALTH
110176759OtherTRAVELERS RR MEDICARE
209383OtherANTHEM OBICI
264925OtherMAMSI OPT CHOICE
100000220OtherMEDICARE TRAILBLAZERS
541870984OtherVA HEALTH NETWORK
541870984006OtherCHAMPUS
69328OtherSENTARA OPTIMA
VA005820154Medicaid
NC790528LMedicaid
C05825OtherMEDICARE GROUP
325221OtherANTHEM HBV
C05825OtherMEDICARE GROUP
110176759OtherTRAVELERS RR MEDICARE