Basic Information
| Provider Information | |||||||||
| NPI: | 1972554368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUNN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11200 RACETRACK RD STE A104 | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218113809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109731030 | ||||||||
| FaxNumber: | 4109731029 | ||||||||
| Practice Location | |||||||||
| Address1: | 11101 CATHAGE RD. | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109126104 | ||||||||
| FaxNumber: | 4109126105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 01/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D58106 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.