Basic Information
| Provider Information | |||||||||
| NPI: | 1356317366 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DUNN | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | PROVIDER ENROLLMENT DEPT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | A.I. DUPONT HOSPITAL FOR CHILDREN | ||||||||
| Address2: | 1600 ROCKLAND ROAD | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514000 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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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 | 204F00000X | C10005966 | DE | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 2086S0120X | C10005966 | DE | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 010233631 | 05 | VA | MEDICAID | 001085174 | 05 | PA | MEDICAID | 3686507 | 05 | NJ | MEDICAID | 6483810 | 05 | MD | MEDICAID | Q05966 | 05 | SC | MEDICAID |