Provider Demographics
NPI:1336170851
Name:DUPONT, DOREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:DUPONT
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 1:545 METRO PL S
Mailing Address - Street 2:SUITE 100, PMB 900
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1343
Mailing Address - Country:US
Mailing Address - Phone:941-350-6772
Mailing Address - Fax:
Practice Address - Street 1:545 METRO PLACE SOUTH
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:941-350-6772
Practice Address - Fax:718-374-5371
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.048938207QA0505X, 207NS0135X, 207QA0401X, 208D00000X, 202C00000X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA15591Medicare UPIN