Provider Demographics
NPI:1174580260
Name:GUNGON, TERESITA (MD)
Entity type:Individual
Prefix:
First Name:TERESITA
Middle Name:
Last Name:GUNGON
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 1:253 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-1111
Mailing Address - Country:US
Mailing Address - Phone:585-335-2296
Mailing Address - Fax:585-335-2299
Practice Address - Street 1:253 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1111
Practice Address - Country:US
Practice Address - Phone:585-335-2296
Practice Address - Fax:585-335-2299
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00051134001OtherUNIVERA
NM2837OtherBLUE SHIELD OF ROCHESTER
NY5174022OtherAETNA
NY0086371OtherGROUP HEALTH INCORPORATED
NY1012176CKOtherPREFERRED CARE
NY00468153Medicaid
NY0086371OtherGROUP HEALTH INCORPORATED
NM2837OtherBLUE SHIELD OF ROCHESTER