Basic Information
| Provider Information | |||||||||
| NPI: | 1346367935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 PARK CLUB LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168364646 | ||||||||
| FaxNumber: | 7168364696 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 PARK CLUB LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168364646 | ||||||||
| FaxNumber: | 7168364696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 243320-1 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 02860566 | 05 | NY | MEDICAID | 071123000015 | 01 | FIDELIS | OTHER | P010243320 | 01 | BLUE CHOICE | OTHER | 00028071901 | 01 | UNIVERA | OTHER | 000529108007 | 01 | BLUE SHIELD WNY | OTHER | 1614241 | 01 | INDEPENDENT HEALTH | OTHER | P020243320 | 01 | ROCHESTER BLUE SHIELD | OTHER | 000529108001 | 01 | BLUE SHIELD WNY | OTHER | 203765FF | 01 | PREFERRED CARE | OTHER | 2433209B | 01 | NY | WORKERS COMPENSATION | OTHER | 177879 | 01 | GHI | OTHER | 243320-9 | 01 | NY | WORKERS COMP | OTHER |