Provider Demographics
NPI:1972554368
Name:GUNN, WILLIAM EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWARD
Last Name:GUNN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11200 RACETRACK RD STE A104
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3809
Mailing Address - Country:US
Mailing Address - Phone:410-973-1030
Mailing Address - Fax:410-973-1029
Practice Address - Street 1:11101 CATHAGE RD.
Practice Address - Street 2:SUITE 102
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-912-6104
Practice Address - Fax:410-912-6105
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD58106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH08628Medicare UPIN