Provider Demographics
NPI:1245290907
Name:MAXWELL, DAVID B (MD)
Entity type:Individual
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First Name:DAVID
Middle Name:B
Last Name:MAXWELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:850 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6251
Practice Address - Country:US
Practice Address - Phone:757-534-6109
Practice Address - Fax:757-534-6096
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-10-07
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Provider Licenses
StateLicense IDTaxonomies
VA0101033417207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C47466Medicare UPIN
C47466Medicare UPIN
VA006031455Medicaid