Provider Demographics
NPI:1376582841
Name:BRESTICKER, DAVID HYMAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HYMAN
Last Name:BRESTICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1205 RIVER AVE FL 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3724
Practice Address - Country:US
Practice Address - Phone:570-323-5991
Practice Address - Fax:570-323-6578
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042068E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012069590013Medicaid
PA610943F6KMedicare PIN
PABR610943OtherPA BLUE SHIELD
P00313605OtherMCRR
PAE55668Medicare UPIN