Healthcare Provider Details

I. General information

NPI: 1861419871
Provider Name (Legal Business Name): JENNIFER ELAINE DUNLAVY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13010 HENSON CT
OAK HILL VA
20171-2938
US

IV. Provider business mailing address

1050 W PERIMETER RD
ANDREWS AFB MD
20762-6601
US

V. Phone/Fax

Practice location:
  • Phone: 210-386-8433
  • Fax:
Mailing address:
  • Phone: 210-386-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101242889
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01062189A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: