Healthcare Provider Details

I. General information

NPI: 1114243359
Provider Name (Legal Business Name): MAUREEN NUCCIO DUNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1164 HAMPTON GARDENS LN
CHARLOTTE NC
28209-2013
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-3658
  • Fax:
Mailing address:
  • Phone: 626-825-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number164700
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA124737
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: