Provider Demographics
NPI:1679505382
Name:WUNDERLICH, CARYN CORNELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:CORNELIA
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1400 DOWELL SPRINGS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2457
Mailing Address - Country:US
Mailing Address - Phone:865-584-0291
Mailing Address - Fax:865-584-4426
Practice Address - Street 1:1400 DOWELL SPRINGS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2456
Practice Address - Country:US
Practice Address - Phone:865-584-0291
Practice Address - Fax:865-584-4426
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD 00000263252085R0202X
TNMD263252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3088874Medicaid
TN3721933Medicare ID - Type Unspecified
TN3088874Medicaid
B66907Medicare UPIN
TN3088878Medicare PIN