Provider Demographics
NPI:1265505655
Name:DOUGLAS A DUNLAP, DO, INC
Entity Type:Organization
Organization Name:DOUGLAS A DUNLAP, DO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-544-8113
Mailing Address - Street 1:654 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4356
Mailing Address - Country:US
Mailing Address - Phone:330-544-8113
Mailing Address - Fax:330-544-8164
Practice Address - Street 1:654 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4356
Practice Address - Country:US
Practice Address - Phone:330-544-8113
Practice Address - Fax:330-544-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-3463-D207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265505655OtherCORPORATE NPI
OH34-00-3463-DOtherSTATE MEDICAL LICENSE
OH0652137Medicaid
OH34-00-3463-DOtherSTATE MEDICAL LICENSE