Provider Demographics
NPI:1396773164
Name:VANDENBERG, DAVID DUANE (PHD, MAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DUANE
Last Name:VANDENBERG
Suffix:
Gender:M
Credentials:PHD, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2631
Mailing Address - Country:US
Mailing Address - Phone:301-657-2389
Mailing Address - Fax:
Practice Address - Street 1:4933 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2631
Practice Address - Country:US
Practice Address - Phone:301-657-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU740171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist