Provider Demographics
NPI:1689650749
Name:AMOS, DAVID BRADLEY (MD PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRADLEY
Last Name:AMOS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9146
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2001 EHRMAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-2271
Practice Address - Country:US
Practice Address - Phone:724-473-0660
Practice Address - Fax:724-473-0665
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060204L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017822320005Medicaid
183922OtherHEALTH AMERICA HLTH INS
611419022OtherUNITED HEALTHCARE
207949OtherUPMC HEALTH PLANS
2873486OtherAETNA HMO
PA0017822320003Medicaid
7932047OtherAETNA PPO
PA0017822320003Medicaid
207949OtherUPMC HEALTH PLANS