Provider Demographics
NPI:1043288525
Name:DUNSTAN, EDWARD J (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:DUNSTAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1258
Mailing Address - Country:US
Mailing Address - Phone:207-723-5173
Mailing Address - Fax:207-723-3040
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1258
Practice Address - Country:US
Practice Address - Phone:207-723-5173
Practice Address - Fax:207-723-3040
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7411174OtherAETNA US HEALTHCARE
2182097OtherFIRST HEALTH
MEMM9028Medicare ID - Type Unspecified
7411174OtherAETNA US HEALTHCARE