Basic Information
| Provider Information | |||||||||
| NPI: | 1164414678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEYSHER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173761180 | ||||||||
| FaxNumber: | 7172736937 | ||||||||
| Practice Location | |||||||||
| Address1: | 954 ISABEL DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170427482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173761180 | ||||||||
| FaxNumber: | 7172736937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | OS005373L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 105170 | 01 | HIGHMARK BLUE SHIELD | OTHER | 01554001 | 01 | CAPITAL BLUE CROSS | OTHER | 1512967 | 01 | GATEWAY HEALTH PLAN | OTHER | 0010798740005 | 05 | PA | MEDICAID |