Basic Information
| Provider Information | |||||||||
| NPI: | 1699702209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNLEAVY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD STE 411 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843301377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 334 MAIN ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | DICKSON CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185191620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703071767 | ||||||||
| FaxNumber: | 5703071770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA000779L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.