Provider Demographics
NPI:1174519706
Name:DUNDON, MARY CATHERINE (MD)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:DUNDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 BUSINESS PARK CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3676
Mailing Address - Country:US
Mailing Address - Phone:615-851-7865
Mailing Address - Fax:615-851-7853
Practice Address - Street 1:3103 BUSINESS PARK CIR STE 100
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3676
Practice Address - Country:US
Practice Address - Phone:615-851-7865
Practice Address - Fax:615-851-7853
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13313208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2026486010OtherCIGNA HMO
2026486012OtherCIGNA COMM
1240402OtherUNITED HEALTHCARE & HMO
TN3127864OtherBLUE CROSS
677768OtherAETNA
TN3000344Medicaid
A96606Medicare UPIN