Provider Demographics
NPI:1740263144
Name:MCTAGUE, DAVID WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:MCTAGUE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 HIGHLAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9424
Mailing Address - Country:US
Mailing Address - Phone:610-868-1100
Mailing Address - Fax:610-868-1111
Practice Address - Street 1:95 HIGHLAND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9424
Practice Address - Country:US
Practice Address - Phone:610-868-1100
Practice Address - Fax:610-868-1111
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000494363AS0400X
PAMA052660363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ 07177Medicare UPIN
DE018041D47Medicare ID - Type UnspecifiedNEUROSURGERY