Provider Demographics
NPI:1861492050
Name:FOULK, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:FOULK
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 1:1140 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6318
Mailing Address - Country:US
Mailing Address - Phone:740-387-2244
Mailing Address - Fax:740-382-8667
Practice Address - Street 1:1140 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6318
Practice Address - Country:US
Practice Address - Phone:740-387-2244
Practice Address - Fax:740-382-8667
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0559079Medicaid
F00557873Medicare ID - Type Unspecified
A81484Medicare UPIN