Provider Demographics
NPI:1962508978
Name:DUNMORE, GWENDOLYN L (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:L
Last Name:DUNMORE
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 1:8305 OSAGE TER
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1758
Mailing Address - Country:US
Mailing Address - Phone:301-204-1172
Mailing Address - Fax:
Practice Address - Street 1:1627 KENILWORTH AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2010
Practice Address - Country:US
Practice Address - Phone:202-803-2340
Practice Address - Fax:202-803-2350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15683207V00000X
MDD0035452207V00000X
DCCS9609574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143173OtherMAMSI/UNITED HEALTHCARE
0001OtherBLUE CROSS BLUE SHIELD ID
3001OtherNEIC SITE ID, NSF BA07
214040OtherMAMSI/MDIPA/ALLIANCE
5041255OtherAETNA PROVIDER ID
521574335OtherTAX ID
11490001OtherBLUE CROSS BLUE SHIELD NA
1894GLOtherBLUECROSSBLUESHIELD OF MD
MD279151000Medicaid
521474335OtherAMERIGROUP AMERCAID
550637OtherUNITED HEALTHCARE
521574335OtherTAX ID
5041255OtherAETNA PROVIDER ID
MD279151000Medicaid