Provider Demographics
NPI:1831196930
Name:EMMERT, DAVID H (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:EMMERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MANOR AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-1132
Mailing Address - Country:US
Mailing Address - Phone:717-295-5524
Mailing Address - Fax:
Practice Address - Street 1:16A MANOR AVE
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1123
Practice Address - Country:US
Practice Address - Phone:717-872-5444
Practice Address - Fax:717-872-1537
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066373L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01707130Medicaid
PA019773Medicare ID - Type Unspecified
PA01707130Medicaid