Provider Demographics
NPI:1659663730
Name:DUNPHY, GERARD KARL (PA)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:KARL
Last Name:DUNPHY
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 1:953 DANBY RD.
Mailing Address - Street 2:HAMMOND HEALTH CENTER AT ITHACA COLLEGE
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-7000
Mailing Address - Country:US
Mailing Address - Phone:607-274-3177
Mailing Address - Fax:607-274-1844
Practice Address - Street 1:953 DANBY RD
Practice Address - Street 2:HAMMOND HEALTH CENTER AT ITHACA COLLEGE
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-7000
Practice Address - Country:US
Practice Address - Phone:607-274-3177
Practice Address - Fax:607-274-1844
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001898363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant