Healthcare Provider Details

I. General information

NPI: 1063952463
Provider Name (Legal Business Name): DAVID LAFFERTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PRIDES XING STE 200
NEWARK DE
19713-6109
US

IV. Provider business mailing address

4190 CITY AVE
PHILADELPHIA PA
19131-1626
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number320800-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: