Provider Demographics
NPI:1578527768
Name:DUNN, TED ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:ALAN
Last Name:DUNN
Suffix:
Gender:M
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:3510 N HIGHWAY 17 STE 320
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8232
Practice Address - Country:US
Practice Address - Phone:843-971-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC129319Medicaid
SCP00689008OtherRAILROAD MEDICARE ID-ROPER BEFORE 5/1/09
SCP00813610OtherRAILROAD MEDICARE ID-RSFPN
SCP00377803OtherRR MEDICARE
SCD178904888Medicare PIN
SCP00377803OtherRR MEDICARE
SC129319Medicaid
SCD178905551Medicare PIN
SCD178906795Medicare PIN