Provider Demographics
NPI:1356385017
Name:DUNDAS, G RICHARD (MD)
Entity type:Individual
Prefix:
First Name:G
Middle Name:RICHARD
Last Name:DUNDAS
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 1:339 DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-5006
Mailing Address - Country:US
Mailing Address - Phone:802-442-8164
Mailing Address - Fax:802-442-4214
Practice Address - Street 1:339 DEWEY ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-5006
Practice Address - Country:US
Practice Address - Phone:802-442-8164
Practice Address - Fax:802-442-4214
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT42-005292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361564Medicaid
11293OtherMOHAWK VALLEY HEALTH PLAN
4376789OtherCIGNA
VT000-4550Medicaid
VT5880241OtherAETNA
VT5880241OtherAETNA
NY00361564Medicaid