Provider Demographics
NPI:1811465727
Name:DG MEDICAL P L L C
Entity type:Organization
Organization Name:DG MEDICAL P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-779-0187
Mailing Address - Street 1:305 LORIMER DR
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2113
Mailing Address - Country:US
Mailing Address - Phone:215-779-0187
Mailing Address - Fax:833-300-9393
Practice Address - Street 1:8080 OLD YORK RD STE 207
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1426
Practice Address - Country:US
Practice Address - Phone:215-779-0187
Practice Address - Fax:833-300-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty