Provider Demographics
NPI:1063401602
Name:DUNBAR, MARY JOSEPHINE (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOSEPHINE
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2649
Mailing Address - Country:US
Mailing Address - Phone:315-458-6601
Mailing Address - Fax:315-458-7940
Practice Address - Street 1:7270 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2649
Practice Address - Country:US
Practice Address - Phone:315-458-6601
Practice Address - Fax:315-458-7940
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00595482Medicaid
NYG80351Medicare UPIN
NY00595482Medicaid