Provider Demographics
NPI:1689165318
Name:DUNLEAVY, MARK LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:DUNLEAVY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:325 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1617
Mailing Address - Country:US
Mailing Address - Phone:609-924-8131
Mailing Address - Fax:
Practice Address - Street 1:325 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1617
Practice Address - Country:US
Practice Address - Phone:609-924-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA12311800207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery