Provider Demographics
NPI:1629021951
Name:MORRIS, DAVID LYTTELTON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LYTTELTON
Last Name:MORRIS
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 75268
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5268
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:590 PETER JEFFERSON PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4628
Practice Address - Country:US
Practice Address - Phone:434-654-8930
Practice Address - Fax:434-654-8931
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00915498Medicare PIN
VAB09849Medicare UPIN
VAVAA103422Medicare PIN