Provider Demographics
NPI:1508817636
Name:PRAGER, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PRAGER
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 1:2851 BAGLYOS CIR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8033
Mailing Address - Country:US
Mailing Address - Phone:610-867-7134
Mailing Address - Fax:610-867-7108
Practice Address - Street 1:2851 BAGLYOS CIR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8033
Practice Address - Country:US
Practice Address - Phone:610-867-7134
Practice Address - Fax:610-867-7108
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054167L207Y00000X
NJ25MA05769700207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAN97834OtherAMERIHEALTH ADMINISTRATOR
PA03212301OtherCAPITAL BLUE CROSS
PA454685OtherHIGHMARK BLUE SHIELD
PA0015107980001Medicaid
PA513832OtherAETNA USHC
PAP2089838OtherOXFORD HEALTH PLAN
PA110090616OtherRAILROAD MEDICARE
PA513832OtherAETNA USHC
PA03212301OtherCAPITAL BLUE CROSS