Provider Demographics
NPI:1891088431
Name:DUNN, BRYAN JOSEPH
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JOSEPH
Last Name:DUNN
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 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:601 W. GEORGE ST.
Practice Address - Street 2:
Practice Address - City:CARMICHAELS
Practice Address - State:PA
Practice Address - Zip Code:15301-1325
Practice Address - Country:US
Practice Address - Phone:724-966-5081
Practice Address - Fax:724-966-9002
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA328834A764918OtherBEHAVIORAL HEALTH - VALUE OPTIONS
PA1007088440093Medicaid