Provider Demographics
NPI:1275535429
Name:DURICA, DAVID LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEWIS
Last Name:DURICA
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 7429
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0429
Mailing Address - Country:US
Mailing Address - Phone:757-397-1201
Mailing Address - Fax:757-398-0809
Practice Address - Street 1:2929 LONDON BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3405
Practice Address - Country:US
Practice Address - Phone:757-397-1201
Practice Address - Fax:757-398-0809
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006436421Medicaid
VAB07323Medicare UPIN
VA006436421Medicaid
VA201951507Medicare ID - Type Unspecified