Healthcare Provider Details

I. General information

NPI: 1649815671
Provider Name (Legal Business Name): JOHN W DUNKLE, MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

5155 CALIFORNIA LN
ALEXANDRIA VA
22304-8670
US

V. Phone/Fax

Practice location:
  • Phone: 571-403-1351
  • Fax:
Mailing address:
  • Phone: 720-982-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN WHITCOMB DUNKLE
Title or Position: OWNER
Credential: MD
Phone: 720-982-6386