Provider Demographics
NPI:1871507160
Name:DUNN GASTROENTEROLOGY, P.A.
Entity Type:Organization
Organization Name:DUNN GASTROENTEROLOGY, P.A.
Other - Org Name:DUNN GASTROENTEROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-892-0044
Mailing Address - Street 1:861 TILGHMAN DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5994
Mailing Address - Country:US
Mailing Address - Phone:910-892-0044
Mailing Address - Fax:910-892-9055
Practice Address - Street 1:861 TILGHMAN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5994
Practice Address - Country:US
Practice Address - Phone:910-892-0044
Practice Address - Fax:910-892-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137XJMedicaid
NC89137XJMedicaid