Provider Demographics
NPI:1336185503
Name:DUNN, CHURCHILL G II (MD)
Entity Type:Individual
Prefix:
First Name:CHURCHILL
Middle Name:G
Last Name:DUNN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C
Other - Middle Name:GIBSON
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:131 ELDEN ST SUITE 150
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170
Mailing Address - Country:US
Mailing Address - Phone:703-402-4941
Mailing Address - Fax:703-430-9293
Practice Address - Street 1:131 ELDEN ST #150
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4876
Practice Address - Country:US
Practice Address - Phone:703-402-4941
Practice Address - Fax:703-430-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010273472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB07097Medicare UPIN
VA017429M25Medicare ID - Type UnspecifiedPHYSICIAN
DC118289Medicare PIN