Healthcare Provider Details

I. General information

NPI: 1528173788
Provider Name (Legal Business Name): GERALD DUNHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST SUITE C-15
PRINCETON NJ
08540-2757
US

IV. Provider business mailing address

601 EWING ST SUITE C-15
PRINCETON NJ
08540-2757
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-2300
  • Fax: 609-921-9137
Mailing address:
  • Phone: 609-921-2300
  • Fax: 609-921-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA04070100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: