Basic Information
| Provider Information | |||||||||
| NPI: | 1922066026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUNDEL | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 84 | ||||||||
| Address2: | |||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 053020084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028626312 | ||||||||
| FaxNumber: | 8026583984 | ||||||||
| Practice Location | |||||||||
| Address1: | 364 DORSET ST | ||||||||
| Address2: | SUITE1 | ||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028626312 | ||||||||
| FaxNumber: | 8026583984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 10/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 042-0004309 | VT | N | Other Service Providers | Specialist | 207RC0000X | 042-0004309 | VT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0004977 | 05 | VT | MEDICAID | 060026200 | 01 | VT | RR MEDICARE | OTHER | 00662184 | 05 | NY | MEDICAID |