Provider Demographics
NPI:1922066026
Name:GUNDEL, WALTER D (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:D
Last Name:GUNDEL
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 84
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0084
Mailing Address - Country:US
Mailing Address - Phone:802-862-6312
Mailing Address - Fax:802-658-3984
Practice Address - Street 1:364 DORSET ST
Practice Address - Street 2:SUITE1
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6270
Practice Address - Country:US
Practice Address - Phone:802-862-6312
Practice Address - Fax:802-658-3984
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0004309174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004977Medicaid
VT060026200OtherRR MEDICARE
NY00662184Medicaid
B85505Medicare UPIN
VTVT4977Medicare ID - Type Unspecified