Provider Demographics
NPI:1679574818
Name:BENJAMIN E DUNLAP MD PA
Entity type:Organization
Organization Name:BENJAMIN E DUNLAP MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-872-7636
Mailing Address - Street 1:925 THOMAS ST
Mailing Address - Street 2:FAMILY PRACTICS
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3484
Mailing Address - Country:US
Mailing Address - Phone:704-872-7636
Mailing Address - Fax:704-872-7750
Practice Address - Street 1:925 THOMAS ST
Practice Address - Street 2:FAMILY PRACTICS
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3484
Practice Address - Country:US
Practice Address - Phone:704-872-7636
Practice Address - Fax:704-872-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929417Medicaid
C80505Medicare UPIN
NC201176Medicare PIN