Provider Demographics
NPI:1649346776
Name:DAVID, HENRY EDWARD (DO)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:EDWARD
Last Name:DAVID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SOUTHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-751-1206
Mailing Address - Fax:856-795-3772
Practice Address - Street 1:1401 RT 70 E
Practice Address - Street 2:STE 10 SOUTH JERSEY MEDICAL CENTER
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-795-3733
Practice Address - Fax:856-795-3772
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MBO2347300207X00000X
NY140960207X00000X
PAOS002625L207X00000X
ND9225207X00000X
VA0102201727207X00000X
GA057205207X00000X
MO2006003817207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA41877Medicare ID - Type Unspecified
C52936Medicare UPIN