Basic Information
Provider Information
NPI: 1003293887
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TUNDO
FirstName: GINA
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MEDICAL CENTER DR
Address2: DHMC
City: LEBANON
State: NH
PostalCode: 037561000
CountryCode: US
TelephoneNumber: 7168662167
FaxNumber:  
Practice Location
Address1: 1 MEDICAL CENTER DR
Address2: DHMC
City: LEBANON
State: NH
PostalCode: 037561000
CountryCode: US
TelephoneNumber: 7168662167
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/30/2015
LastUpdateDate: 08/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X85774GAY Allopathic & Osteopathic PhysiciansUrology 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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