Provider Demographics
NPI:1942287727
Name:DAVID, DENNIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:DAVID
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 1:1551 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6022
Mailing Address - Country:US
Mailing Address - Phone:518-372-0487
Mailing Address - Fax:518-372-1189
Practice Address - Street 1:1551 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6022
Practice Address - Country:US
Practice Address - Phone:518-372-0487
Practice Address - Fax:518-372-1189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116158208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527197Medicaid
1161587BOtherWORKERS COMPENSATION
02104OtherMVP
10000445OtherCDPHP
344201OtherEMPIRE BLUE CROSS BLUE SI
344201OtherEMPIRE BLUE CROSS BLUE SI
02104OtherMVP