Provider Demographics
NPI:1962454207
Name:WITHERS, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:WITHERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:LILY LAKE RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:PA
Practice Address - Zip Code:18471
Practice Address - Country:US
Practice Address - Phone:570-563-1112
Practice Address - Fax:570-563-1138
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD0423556207P00000X
PAMD423556207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B82916Medicare UPIN