Provider Demographics
NPI:1255342440
Name:DUNLAP, MARK EVANS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVANS
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:EVANS
Other - Last Name:DIBNER-DUNLAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5421 HERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2125
Mailing Address - Country:US
Mailing Address - Phone:216-780-1766
Mailing Address - Fax:216-778-3927
Practice Address - Street 1:2500 METROHEALTH DR.
Practice Address - Street 2:METROHEALTH MEDICAL CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-780-1766
Practice Address - Fax:216-778-3927
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059178207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDU4082031Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER