Healthcare Provider Details

I. General information

NPI: 1124045802
Provider Name (Legal Business Name): SAMANTHA MARY DUNHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BROADWAY FL 4
NEW YORK NY
10006-1978
US

IV. Provider business mailing address

111 BROADWAY FL 4
NEW YORK NY
10006-1978
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-9700
  • Fax: 212-263-9701
Mailing address:
  • Phone: 212-263-9700
  • Fax: 212-263-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number228598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: