Healthcare Provider Details

I. General information

NPI: 1699902528
Provider Name (Legal Business Name): SUZANNE LEBIDA DUNDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E APPLE ST WRIGHT STATE UNIV DEPT OF INTERNAL MEDICINE, 2ND FLOOR
DAYTON OH
45409-2902
US

IV. Provider business mailing address

128 E APPLE ST WRIGHT STATE UNIV DEPT OF INTERNAL MEDICINE, 2ND FLOOR
DAYTON OH
45409-2902
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2866
  • Fax:
Mailing address:
  • Phone: 937-208-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA09664300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: