Provider Demographics
NPI:1710350004
Name:HUMPHREY, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:MCCLURE
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 HARFORD LN
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4529
Mailing Address - Country:US
Mailing Address - Phone:610-688-7110
Mailing Address - Fax:
Practice Address - Street 1:6 HARFORD LN
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4529
Practice Address - Country:US
Practice Address - Phone:610-688-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045136L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology