Provider Demographics
NPI:1962508978
Name:DUNMORE, GWENDOLYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:L
Last Name:DUNMORE
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 1:3321 TOLEDO TERRACE
Mailing Address - Street 2:SUITE D102
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4150
Mailing Address - Country:US
Mailing Address - Phone:301-559-2400
Mailing Address - Fax:301-509-2403
Practice Address - Street 1:3321 TOLEDO TERRACE
Practice Address - Street 2:SUITE D102
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4150
Practice Address - Country:US
Practice Address - Phone:301-559-2400
Practice Address - Fax:301-509-2403
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035452207V00000X
DCCS9609574207V00000X
DCMD15683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3001OtherNEIC SITE ID, NSF BA07
550637OtherUNITED HEALTHCARE
1894GLOtherBLUECROSSBLUESHIELD OF MD
521474335OtherAMERIGROUP AMERCAID
2143173OtherMAMSI/UNITED HEALTHCARE
0001OtherBLUE CROSS BLUE SHIELD ID
11490001OtherBLUE CROSS BLUE SHIELD NA
MD279151000Medicaid
214040OtherMAMSI/MDIPA/ALLIANCE
5041255OtherAETNA PROVIDER ID
521574335OtherTAX ID
521574335OtherTAX ID
5041255OtherAETNA PROVIDER ID
MD279151000Medicaid