Provider Demographics
NPI:1164458295
Name:DUNKIN-ALBA, DONA (DO)
Entity Type:Individual
Prefix:
First Name:DONA
Middle Name:
Last Name:DUNKIN-ALBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DONA
Other - Middle Name:RAE
Other - Last Name:DUNKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0228
Mailing Address - Country:US
Mailing Address - Phone:740-385-0202
Mailing Address - Fax:740-385-0505
Practice Address - Street 1:751 STATE ROUTE 664 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9250
Practice Address - Country:US
Practice Address - Phone:740-385-0202
Practice Address - Fax:740-385-0505
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016681207Q00000X
OH34-006481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114849101Medicaid
OH0312594Medicaid
MIG30798Medicare UPIN
OH0312594Medicaid