Healthcare Provider Details

I. General information

NPI: 1215928973
Provider Name (Legal Business Name): JOHN WILLIAM DORUNDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE NBHC GROTON
GROTON CT
06340-2324
US

IV. Provider business mailing address

1 WAHOO AVENUE NBHC GROTON
GROTON CT
06349-5600
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-4123
  • Fax: 860-694-1330
Mailing address:
  • Phone: 860-694-4123
  • Fax: 860-694-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101222938
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: