Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD60575988 | WA |
Y | 2081S0010X | Sports Medicine | 61182 | CT |
Y | 213ES0000X | Sports Medicine | 61182 | CT |
NPI | 1508282492 |
---|---|
Provider Name | Dr. Mark Dundas |
First Address | New Haven, CT 06519-1369 |
Second Address | New Haven, CT 06511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2014 |
Last Update Date | 08/08/2018 |