Provider Demographics
NPI:1629169867
Name:DUNDA, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:DUNDA
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 6
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0006
Mailing Address - Country:US
Mailing Address - Phone:864-260-4607
Mailing Address - Fax:864-260-4577
Practice Address - Street 1:1011 ELLA ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4807
Practice Address - Country:US
Practice Address - Phone:864-260-4607
Practice Address - Fax:864-260-4577
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39950207PE0004X, 202C00000X, 207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B82511Medicare UPIN
NY39668CMedicare ID - Type Unspecified
NY00679589Medicaid