Provider Demographics
NPI:1073540076
Name:AXELROD, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:AXELROD
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 1:1620 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4637
Mailing Address - Country:US
Mailing Address - Phone:717-843-6663
Mailing Address - Fax:717-852-0670
Practice Address - Street 1:1620 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4637
Practice Address - Country:US
Practice Address - Phone:717-843-6663
Practice Address - Fax:717-852-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035945207RR0500X
NJ25MA08321700207KA0200X
PAMD447274207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0635238OtherBLUE SHEILD OF MICHIGAN
MI0635238OtherBLUE SHEILD OF MICHIGAN
MIB43718Medicare UPIN