Provider Demographics
NPI:1669896957
Name:DAVID, NOAH (PA-C)
Entity type:Individual
Prefix:MR
First Name:NOAH
Middle Name:
Last Name:DAVID
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 1:2602 BUFORD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3422
Mailing Address - Country:US
Mailing Address - Phone:804-272-8806
Mailing Address - Fax:804-272-2909
Practice Address - Street 1:2602 BUFORD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3422
Practice Address - Country:US
Practice Address - Phone:804-272-8806
Practice Address - Fax:804-272-2909
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant