Provider Demographics
NPI:1144341462
Name:DAVID J. DUNCH, M. D., INC.
Entity type:Organization
Organization Name:DAVID J. DUNCH, M. D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:330-757-8425
Mailing Address - Street 1:250 DEBARTOLO PL
Mailing Address - Street 2:SUITE 1640
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7004
Mailing Address - Country:US
Mailing Address - Phone:330-757-8425
Mailing Address - Fax:330-726-2602
Practice Address - Street 1:250 DEBARTOLO PL
Practice Address - Street 2:SUITE 1640
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-7004
Practice Address - Country:US
Practice Address - Phone:330-726-2602
Practice Address - Fax:330-726-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 051938208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000140049OtherANTHEM BC BS PIN NUMBER
OH0593424Medicaid
OH169380393002OtherMEDICAL MUTUAL
OH2800000614OtherMEDICARE RAILROAD
OH14-0007OtherMEDICARE UNITED HEALTHCAR
OH0593424Medicaid