Provider Demographics
NPI:1710169164
Name:DUNLAP, BENJAMIN E (M D)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 THOMAS ST
Mailing Address - Street 2:C
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3484
Mailing Address - Country:US
Mailing Address - Phone:704-872-7636
Mailing Address - Fax:704-872-7550
Practice Address - Street 1:925 THOMAS ST
Practice Address - Street 2:C
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3484
Practice Address - Country:US
Practice Address - Phone:704-872-7636
Practice Address - Fax:704-872-7550
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929417Medicaid
NC201176Medicare PIN
NC8929417Medicaid