MEDICARE: JENNIFER ELAINE DUNLAVY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	0101242889	VA
2	207P00000X	Emergency Medicine Physician	01062189A	IN

General Provider Information

NPI Number	:	1861419871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELAINE DUNLAVY M.D.

Provider Business Mailing Address
First Line	:	1050 W PERIMETER RD
Second Line	:
City	:	ANDREWS AFB
State	:	MD
Zip	:	20762-6601
Country	:	US
Telephone Number	:	210-386-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	13010 HENSON CT
Second Line	:
City	:	OAK HILL
State	:	VA
Zip	:	20171-2938
Country	:	US
Telephone Number	:	210-386-8433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	03/27/2022

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