Provider Demographics
NPI:1417229816
Name:DUNCAN, DENNIS GREGORY (PA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:GREGORY
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3740
Mailing Address - Country:US
Mailing Address - Phone:540-772-1006
Mailing Address - Fax:540-772-1086
Practice Address - Street 1:3390 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3740
Practice Address - Country:US
Practice Address - Phone:540-772-1006
Practice Address - Fax:540-772-1086
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003793363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical