Basic Information
| Provider Information | |||||||||
| NPI: | 1962763789 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZISA | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 448 | ||||||||
| Address2: | |||||||||
| City: | EAST PETERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175200448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173917092 | ||||||||
| FaxNumber: | 7177352069 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 KEISER BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106858500 | ||||||||
| FaxNumber: | 6106854833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 08/07/2019 | ||||||||
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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 | 207R00000X | 252200 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.