Provider Demographics
NPI:1750386066
Name:ADCOCK, DAVID WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:ADCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:675 BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-7900
Practice Address - Country:US
Practice Address - Phone:570-808-6400
Practice Address - Fax:570-808-6338
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA052405208200000X
PAMD483668208200000X
TNMD0000020999208200000X
MS23882208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4059237OtherTN BCBS - PLASTIC SURGERY
GA24BCBTPMedicare PIN
GA305312874AMedicaid
TN3730614Medicare PIN