Provider Demographics
NPI:1326161167
Name:DEAS, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:DEAS
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 1:1006B UNION RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5591
Mailing Address - Country:US
Mailing Address - Phone:704-867-2338
Mailing Address - Fax:704-867-2330
Practice Address - Street 1:1006B UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5591
Practice Address - Country:US
Practice Address - Phone:704-867-2338
Practice Address - Fax:704-867-2330
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC28010OtherBCBS
NC8928010Medicaid
C80393Medicare UPIN
NC28010OtherBCBS