Healthcare Provider Details

I. General information

NPI: 1942278460
Provider Name (Legal Business Name): ADRIAN L DUNKERLEY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

1381 EISENHOWER CIR APARTMENT #203
WOODBRIDGE VA
22191-5228
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-5541
  • Fax:
Mailing address:
  • Phone: 703-432-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: