Provider Demographics
NPI:1417920398
Name:PFISTERER, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:PFISTERER
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:110 PLAZA LN
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1773
Practice Address - Country:US
Practice Address - Phone:570-724-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205525-1207Q00000X
PAMD058686L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01665145Medicaid
PAGU039851OtherPA MEDICARE GROUP
PA080089180OtherRR MEDICARE PIN
PA0015959280001Medicaid
PACC9269OtherRR MEDICARE GROUP
PAGU039777OtherPA MEDICARE GROUP
PA888606N8HMedicare ID - Type Unspecified
PAGU039777OtherPA MEDICARE GROUP
PA0015959280001Medicaid