Provider Demographics
NPI:1275533135
Name:ESTOCK, DAVID STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEPHEN
Last Name:ESTOCK
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 1:1403 FOULK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2788
Mailing Address - Country:US
Mailing Address - Phone:302-479-0100
Mailing Address - Fax:302-479-0177
Practice Address - Street 1:1403 FOULK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2788
Practice Address - Country:US
Practice Address - Phone:302-479-0100
Practice Address - Fax:302-479-0177
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2008-03-28
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
DEC1-0003216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE080139009OtherRAILROAD MEDICARE INDIV
DE0000157501Medicaid
ES459113Medicare ID - Type Unspecified
B90167Medicare UPIN