Provider Demographics
NPI:1194312801
Name:DUNLAP, CHARLES M
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1723
Mailing Address - Country:US
Mailing Address - Phone:740-851-3448
Mailing Address - Fax:
Practice Address - Street 1:88 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1723
Practice Address - Country:US
Practice Address - Phone:740-851-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0402466Medicaid