Provider Demographics
NPI:1134252653
Name:GINGRICH, DAVID L (PA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:GINGRICH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5816
Mailing Address - Country:US
Mailing Address - Phone:805-542-9596
Mailing Address - Fax:805-542-0845
Practice Address - Street 1:47 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5816
Practice Address - Country:US
Practice Address - Phone:805-542-9596
Practice Address - Fax:805-542-0845
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17191363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17191OtherLICENSE
CAEV846ZMedicare PIN