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General NPI Number Information
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NPI Number | 1518584432
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Entity Type | Individual
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Provider Name | JUSTIN CHARLES GUNN MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1 WAHOO AVE
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City | GROTON
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State | CT
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Zip | 06349-2324
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Country | US
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Telephone | 860-694-4123
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Fax |
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Provider Business Mailing Address
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Address Line | 8955 WOOD ROAD BUILDING 1, 19TH FLOOR, ROOM 19121
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City | BETHESDA
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State | MD
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Zip | 20889-5628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101276154
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License Number State | VA
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