Basic Information
| Provider Information | |||||||||
| NPI: | 1881738870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVID | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 579 | ||||||||
| Address2: | |||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162010579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438164 | ||||||||
| FaxNumber: | 7245438616 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MEDICAL ARTS BLDG | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438378 | ||||||||
| FaxNumber: | 7245438379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207V00000X | MD036530E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0010551750001 | 05 | PA | MEDICAID | 1014107 | 01 | PA | GATEWAY ID NUMBER | OTHER | 104157 | 01 | PA | UPMC ID NUMBER | OTHER | DA425653 | 01 | PA | BLUE SHIELD ID NUMBER | OTHER | MD036530E | 01 | PA | PA STATE LICENSE | OTHER |