Provider Demographics
NPI:1194786210
Name:DUNZENDORFER, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DUNZENDORFER
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 1:24 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3302
Mailing Address - Country:US
Mailing Address - Phone:413-236-0900
Mailing Address - Fax:413-236-5665
Practice Address - Street 1:24 CHARLES ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3302
Practice Address - Country:US
Practice Address - Phone:413-236-0900
Practice Address - Fax:413-236-5665
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73558207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016907OtherNEIGHBORHOOD HEALTH PLAN
100911OtherMVP
9250030OtherPRIVATE HEALTHCARE SYSTEM
P-12006240OtherMULTIPLAN
10034418OtherCDPHP
23223OtherHEALTH NEW ENGLAND
000000023393OtherBMC HEALTHNET
3288170OtherAETNA
P00661275OtherRAILROAD MEDICARE
P2212790OtherOXFORD
MA110060325AMedicaid
MA073558OtherTUFTS
G41567OtherHARVARD PILGRIM
MAJ19535OtherBCBS
G41567OtherHARVARD PILGRIM
3288170OtherAETNA