Provider Demographics
NPI:1073574612
Name:SISSON, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:SISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:812 AMHERST ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-450-1600
Mailing Address - Fax:540-450-0166
Practice Address - Street 1:812 AMHERST ST
Practice Address - Street 2:STE 201
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-450-1600
Practice Address - Fax:540-450-0166
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221449207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073574612Medicaid
VA298306OtherBLUE CROSS OF VIRGINIA
WV6000048000Medicaid
VA298306OtherBLUE CROSS OF VIRGINIA
G97972Medicare UPIN