Provider Demographics
NPI:1245267350
Name:LAMPORT, DAVID MORRIS (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MORRIS
Last Name:LAMPORT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-1266
Mailing Address - Country:US
Mailing Address - Phone:740-694-1261
Mailing Address - Fax:740-694-7145
Practice Address - Street 1:122 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-1266
Practice Address - Country:US
Practice Address - Phone:740-694-1261
Practice Address - Fax:740-694-7145
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001091RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112903Medicaid