Provider Demographics
NPI:1255326583
Name:STEFFENSEN, DAVID O (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:STEFFENSEN
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:FORBES ROAD
Mailing Address - State:PA
Mailing Address - Zip Code:15633-0205
Mailing Address - Country:US
Mailing Address - Phone:724-219-3904
Mailing Address - Fax:724-219-3524
Practice Address - Street 1:726 LINDWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7711
Practice Address - Country:US
Practice Address - Phone:724-219-3904
Practice Address - Fax:724-219-3524
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026414E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00095318940006Medicaid
PA135048Medicare ID - Type UnspecifiedMEDICARE NUMBER
PAB38106Medicare UPIN