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General NPI Number Information
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NPI Number | 1811954506
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Entity Type | Individual
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Provider Name | GREGORY A VAN GUNDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 01/31/2011
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Provider Practice Location Address
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Address Line | 9 HEALTHCARE DRIVE SUITE 101
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City | BIDDEFORD
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State | ME
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Zip | 04005-9407
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Country | US
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Telephone | 207-282-4270
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Fax | 207-282-7350
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Provider Business Mailing Address
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Address Line | 9 HEALTHCARE DRIVE SUITE 201
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City | BIDDEFORD
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State | ME
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Zip | 04005-3747
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Country | US
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Telephone | 207-282-9080
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Fax | 207-282-9180
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 015797
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License Number State | ME
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