Provider Demographics
NPI:1790859551
Name:DUNKELBERGER, GREGORY RAY (PA C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:RAY
Last Name:DUNKELBERGER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:R
Other - Last Name:DUNKELBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-986-4346
Mailing Address - Fax:336-995-5101
Practice Address - Street 1:216 MOORE RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8703
Practice Address - Country:US
Practice Address - Phone:336-983-4346
Practice Address - Fax:336-985-5101
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001459363AM0700X
NC0010-01794363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101292Medicaid
NC2762198Medicare PIN