Basic Information
Provider Information
NPI: 1003802760
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNKELBERGER
FirstName: JEFFERY
MiddleName: JUDE
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7 DOCK HILL RD
Address2:  
City: MIDDLEBURG
State: PA
PostalCode: 178428910
CountryCode: US
TelephoneNumber: 5708372123
FaxNumber: 5708372185
Practice Location
Address1: 30 E SHADY LN
Address2:  
City: ENOLA
State: PA
PostalCode: 170252354
CountryCode: US
TelephoneNumber: 7174127500
FaxNumber: 7174098948
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 01/22/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOS009430LPAY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
102823360000105PA MEDICAID
043825F6K01PAMEDICARE PTANOTHER


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