Healthcare Provider Details

I. General information

NPI: 1619321619
Provider Name (Legal Business Name): DAVID DUNAWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 09/28/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 OLD YORK ROAD SUITE 201
JENKINTOWN PA
10946
US

IV. Provider business mailing address

500 OLD YORK RD STE 201
JENKINTOWN PA
19046-2872
US

V. Phone/Fax

Practice location:
  • Phone: 215-517-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD473285
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: