Provider Demographics
NPI:1154436061
Name:TUNGOL, DINAH V (MD)
Entity type:Individual
Prefix:
First Name:DINAH
Middle Name:V
Last Name:TUNGOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-764-3319
Mailing Address - Fax:207-768-5377
Practice Address - Street 1:180 ACADEMY ST STE 2
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3183
Practice Address - Country:US
Practice Address - Phone:207-764-3319
Practice Address - Fax:207-768-5377
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0116342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME300320099Medicaid
ME300320099Medicaid