Provider Demographics
NPI:1104880137
Name:DUNHAM, VICTOR EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:EDWARD
Last Name:DUNHAM
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 1:60 MT. PLEASANT ROAD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216
Mailing Address - Country:US
Mailing Address - Phone:330-882-4934
Mailing Address - Fax:
Practice Address - Street 1:845 8TH ST NE
Practice Address - Street 2:SUITE 3
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8511
Practice Address - Country:US
Practice Address - Phone:330-830-3258
Practice Address - Fax:330-830-6928
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.053779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703865Medicaid
A82978Medicare UPIN
OH35053779Medicare ID - Type Unspecified