Provider Demographics
NPI:1356483887
Name:DAVID, NOEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:C
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 CHERRY LN STE 111
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4397
Mailing Address - Country:US
Mailing Address - Phone:209-647-4545
Mailing Address - Fax:209-707-3147
Practice Address - Street 1:250 CHERRY LN STE 111
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4397
Practice Address - Country:US
Practice Address - Phone:209-647-4545
Practice Address - Fax:209-707-3147
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC51570207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01226553Medicaid
NYCC3659Medicare ID - Type Unspecified
NY01226553Medicaid