Provider Demographics
NPI:1396938460
Name:DUNKIRK FAMILY PRACTICE PA
Entity type:Organization
Organization Name:DUNKIRK FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-286-3865
Mailing Address - Street 1:2025 CHANEYVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-4300
Mailing Address - Country:US
Mailing Address - Phone:410-286-3865
Mailing Address - Fax:410-286-8085
Practice Address - Street 1:2025 CHANEYVILLE RD
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-4352
Practice Address - Country:US
Practice Address - Phone:410-286-3865
Practice Address - Fax:410-286-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD583810000Medicaid
MD583810000Medicaid