Provider Demographics
NPI:1205974532
Name:DAVID, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 W CEDAR LN
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1516
Mailing Address - Country:US
Mailing Address - Phone:301-564-4040
Mailing Address - Fax:301-564-3604
Practice Address - Street 1:16C DEATRICK DRIVE
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-3401
Practice Address - Country:US
Practice Address - Phone:717-337-3300
Practice Address - Fax:717-337-2977
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17912208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
77090009OtherCAREFIRST NATIONAL
50074336OtherCAPITAL BLUE CROSS
PA566819OtherHIGHMARK BLUE SHIELD
PA1020572750002Medicaid
54515439OtherCAREFIRST
MD016731M40Medicare ID - Type Unspecified
PA120204PJKMedicare PIN