Provider Demographics
NPI:1770586653
Name:MOORTHI, DAVID S (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:MOORTHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 W FAYETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2866
Mailing Address - Country:US
Mailing Address - Phone:315-218-5303
Mailing Address - Fax:
Practice Address - Street 1:739 IRVING AVE STE 600
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1663
Practice Address - Country:US
Practice Address - Phone:315-218-5303
Practice Address - Fax:315-471-0411
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2140782081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140788BOtherTRICARE
RC60214078OtherPOMCO
200995527OtherCHAMPUS VA
00026146103OtherUNIVERA
NYP010214078OtherBLUECHOICE
P020214078OtherEXCELLUS BCBS
200995527OtherEMPIRE PLAN
786892OtherMVP
8799848OtherGHI
110836AHOtherPREFERRED CARE
200995527OtherCIGNA
608856700OtherDOL-OWCP
RC60214078OtherNOVA
200995527OtherAMERICAN PROGRESSIVE
7001141OtherAETNA
00026146103OtherUNIVERA
P020214078OtherEXCELLUS BCBS
NYG94591Medicare UPIN