Healthcare Provider Details

I. General information

NPI: 1144341462
Provider Name (Legal Business Name): DAVID J. DUNCH, M. D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL SUITE 1640
YOUNGSTOWN OH
44512-7004
US

IV. Provider business mailing address

250 DEBARTOLO PL SUITE 1640
YOUNGSTOWN OH
44512-7004
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-2602
  • Fax: 330-726-2653
Mailing address:
  • Phone: 330-757-8425
  • Fax: 330-726-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35 051938
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID J DUNCH
Title or Position: PROPRIETOR
Credential: M. D.
Phone: 330-757-8425