Healthcare Provider Details

I. General information

NPI: 1154852580
Provider Name (Legal Business Name): GRETCHEN GUNN-KONDURU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN T GUNN

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S STATE ST
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-3121
  • Fax:
Mailing address:
  • Phone: 406-580-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC1-0028065
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: