Provider Demographics
NPI:1932369030
Name:DUMONT, GUILLAUME DAVID (MD)
Entity Type:Individual
Prefix:
First Name:GUILLAUME
Middle Name:DAVID
Last Name:DUMONT
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:PO BOX 22265
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4473
Mailing Address - Country:US
Mailing Address - Phone:803-296-7846
Mailing Address - Fax:803-296-9699
Practice Address - Street 1:146 E HOSPITAL DR STE 140&350
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-314-9640
Practice Address - Fax:803-314-9641
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254005207XX0005X
SC36781207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC367819Medicaid
SCSC40272488Medicare PIN