Provider Demographics
NPI:1558331330
Name:ARCHER, DAVID FITZGERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FITZGERALD
Last Name:ARCHER
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7100
Mailing Address - Fax:757-446-7455
Practice Address - Street 1:601 COLLEY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1627
Practice Address - Country:US
Practice Address - Phone:757-446-7100
Practice Address - Fax:757-446-7455
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040574207VE0102X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA15021OtherSENTARA OPTIMA
VAPAROtherCORVEL/CORCARE
VA081874OtherANTHEM
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC05077OtherNC BC/BS
415249OtherUHC/MAMSI
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCIGNA
VA-012OtherTRICARE/CHAMPUS
VA006227104Medicaid
VAPAROtherAETNA
VAPAROtherMULTIPLAN
NC7905077Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherAETNA
415249OtherUHC/MAMSI