Provider Demographics
NPI:1558312983
Name:DUNN, JONATHAN H (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:H
Last Name:DUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9601 PULASKI PARK DR
Mailing Address - Street 2:SUITE 416 ATTENTION CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1409
Mailing Address - Country:US
Mailing Address - Phone:410-933-5678
Mailing Address - Fax:410-933-3923
Practice Address - Street 1:700 GEIPE RD
Practice Address - Street 2:SUITE 265
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-4147
Practice Address - Country:US
Practice Address - Phone:410-747-7100
Practice Address - Fax:410-788-7387
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0063392207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106438Medicaid
ILP00457151OtherMEDICARE RAILROAD
IL363062013OtherEIN
ILK38355Medicare PIN
IL363062013OtherEIN
ILK38354Medicare PIN