Provider Demographics
NPI:1801978580
Name:DUNAGIN, WILLIAM GALEN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GALEN
Last Name:DUNAGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:G
Other - Last Name:DUNAGIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD DERMATOLOGY
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 LIVEWELL DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-467-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-034276-E207N00000X
MEMD22175207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013907Medicaid
PA1013907Medicaid
PA185134Medicare ID - Type Unspecified