Active NPI
Aida Dunamalyan, MD
- Psychiatry Physician
- Fargo, ND
National Provider Identifier
1487740510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 10092
- Practice address
- 510 4TH Street S
Fargo, ND 58103 - Phone
- (701) 476-7208
- NPI assigned
- Oct 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 10092 | ND | Primary |
Addresses
Primary practice location
510 4TH Street S
Fargo, ND 58103
Mailing address
2540 36TH Ave SW
310
Fargo, ND 58104
Phone (701) 280-2457
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74116000 | Medicaid | MN | |
| 78G11DU | Other | MN | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10092 | ND | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487740510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2540 36TH AVE SW",
"address_2": "310",
"city": "FARGO",
"state": "ND",
"postal_code": "58104",
"telephone_number": "701-280-2457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 4TH STREET S",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-476-7208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUNAMALYAN",
"first_name": "AIDA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "ND",
"license": "10092",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "74116000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "78G11DU",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.