Healthcare Provider Details

I. General information

NPI: 1932536232
Provider Name (Legal Business Name): EPHRAIM DUNN D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W LEHIGH AVE STE A
PHILADELPHIA PA
19132
US

IV. Provider business mailing address

2101 W LEHIGH AVE STE A
PHILADELPHIA PA
19132-2664
US

V. Phone/Fax

Practice location:
  • Phone: 264-866-7211
  • Fax: 305-698-6536
Mailing address:
  • Phone: 264-866-7211
  • Fax: 305-698-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207Q000X
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS017795
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: