Provider Demographics
NPI:1548208770
Name:PUDLES, DAVID M (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:PUDLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2831 TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1415
Mailing Address - Country:US
Mailing Address - Phone:215-624-2487
Mailing Address - Fax:215-624-0874
Practice Address - Street 1:2831 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1415
Practice Address - Country:US
Practice Address - Phone:215-624-2487
Practice Address - Fax:215-624-0874
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005343L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB36906Medicare UPIN
PA112728VNWMedicare PIN