Provider Demographics
NPI:1033317219
Name:DICKERSON, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 ROUTE 37 W
Mailing Address - Street 2:SUITE 330
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5059
Mailing Address - Country:US
Mailing Address - Phone:732-691-4898
Mailing Address - Fax:732-608-8950
Practice Address - Street 1:780 ROUTE 37 W
Practice Address - Street 2:SUITE 330
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-691-4898
Practice Address - Fax:732-608-8950
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07911500207X00000X
NY246311-1207X00000X
CT045983207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery