Provider Demographics
NPI:1922082155
Name:GUNDY, DEIRDRE JANE (MD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:JANE
Last Name:GUNDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6955
Practice Address - Street 1:5346 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1918
Practice Address - Country:US
Practice Address - Phone:215-747-6661
Practice Address - Fax:215-471-1418
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057887L207V00000X
NJMA074602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37383Medicare UPIN