Provider Demographics
NPI:1255303939
Name:SIU, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:SIU
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 1:1920 QUEENSWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4269
Mailing Address - Country:US
Mailing Address - Phone:717-747-3566
Mailing Address - Fax:717-747-3678
Practice Address - Street 1:1920 QUEENSWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4269
Practice Address - Country:US
Practice Address - Phone:717-747-3566
Practice Address - Fax:717-747-3678
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH82318Medicare UPIN
PA090192PCEMedicare PIN