1144341462 NPI number — DAVID J. DUNCH, M. D., INC.

Table of content: (NPI 1144341462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144341462 NPI number — DAVID J. DUNCH, M. D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID J. DUNCH, M. D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144341462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 DEBARTOLO PL
Provider Second Line Business Mailing Address:
SUITE 1640
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44512-7004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-757-8425
Provider Business Mailing Address Fax Number:
330-726-2602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 DEBARTOLO PL
Provider Second Line Business Practice Location Address:
SUITE 1640
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44512-7004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-726-2602
Provider Business Practice Location Address Fax Number:
330-726-2653
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCH
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PROPRIETOR
Authorized Official Telephone Number:
330-757-8425

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  35 051938 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000140049 . This is a "ANTHEM BC BS PIN NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0593424 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169380393002 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2800000614 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 14-0007 . This is a "MEDICARE UNITED HEALTHCAR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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