Provider Demographics
NPI:1811954506
Name:VAN GUNDY, GREGORY A (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:VAN GUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3747
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:9 HEALTHCARE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9407
Practice Address - Country:US
Practice Address - Phone:207-282-4270
Practice Address - Fax:207-282-7350
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME015797207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1830787OtherCIGNA
MEB34079OtherHARVARD PILGRIM
ME2751613OtherAETNA
ME045032OtherANTHEM
ME318470099Medicaid
ME2751613OtherAETNA
MEMM9273Medicare ID - Type Unspecified
MEB34079OtherHARVARD PILGRIM