Provider Demographics
NPI:1912140963
Name:BRUNDAGE, DHIPTHI ABHILASHINI
Entity Type:Individual
Prefix:
First Name:DHIPTHI
Middle Name:ABHILASHINI
Last Name:BRUNDAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 ACADEMY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2653
Mailing Address - Country:US
Mailing Address - Phone:919-972-8640
Mailing Address - Fax:
Practice Address - Street 1:3001 ACADEMY RD STE 240
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2653
Practice Address - Country:US
Practice Address - Phone:919-972-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-000372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry