Provider Demographics
NPI:1205889631
Name:ROCKWELL, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 ERIE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-4134
Practice Address - Fax:518-243-1417
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY127137207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000443020001OtherBLUE SHIELD
NY10018258OtherCDPHP
NY000000043338OtherGHI- HMO
NY040426010815OtherFIDELIS
NY10454627OtherCAQH
NY32118OtherMVP
NY127137-8WOtherWORKERS COMP
NY69E521OtherBLUE CROSS
NY9691727OtherGHI-PPO
NY7917521OtherAETNA
NY9691727OtherGHI-PPO
NY32118OtherMVP