Provider Demographics
NPI:1740281260
Name:DUNLAP, KENNETH D JR (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:D
Last Name:DUNLAP
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:500 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1335
Mailing Address - Country:US
Mailing Address - Phone:717-718-5511
Mailing Address - Fax:717-718-0660
Practice Address - Street 1:500 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1335
Practice Address - Country:US
Practice Address - Phone:717-718-5511
Practice Address - Fax:717-718-0660
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003723L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1427240OtherHIGHMARK BLUE SHIELD
PA747106VKJOtherMEDICARE PTAN
PA001410291Medicaid
PA02092701OtherCAPITAL BLUE CROSS
PA747106VKJOtherMEDICARE PTAN