Provider Demographics
NPI:1568578847
Name:DUNN, BEVERLY ANDREANA (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANDREANA
Last Name:DUNN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CRESCENT AVENUE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463
Mailing Address - Country:US
Mailing Address - Phone:201-445-0033
Mailing Address - Fax:201-445-2444
Practice Address - Street 1:61 CRESCENT AVENUE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463
Practice Address - Country:US
Practice Address - Phone:201-445-0033
Practice Address - Fax:201-445-2444
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
051604Medicare ID - Type Unspecified
C52803Medicare UPIN