Provider Demographics
NPI:1538129754
Name:MCPHERSON, DAVID PENDLETON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PENDLETON
Last Name:MCPHERSON
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 1:1953 CARROLLTON PIKE
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-0038
Mailing Address - Country:US
Mailing Address - Phone:276-728-3196
Mailing Address - Fax:276-728-4802
Practice Address - Street 1:1953 CARROLLTON PIKE
Practice Address - Street 2:POST OFFICE BOX 38
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-0038
Practice Address - Country:US
Practice Address - Phone:276-728-3196
Practice Address - Fax:276-728-4802
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016177OtherANTHEM
VA005671825Medicaid
VA016177OtherANTHEM
VA005671825Medicaid
VA080015991Medicare PIN