Healthcare Provider Details

I. General information

NPI: 1083642631
Provider Name (Legal Business Name): DAVID A YORK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 CAPITOL ST STE 2
AUGUSTA ME
04330-6235
US

IV. Provider business mailing address

219 CAPITOL ST STE 2
AUGUSTA ME
04330-6235
US

V. Phone/Fax

Practice location:
  • Phone: 207-629-5005
  • Fax: 207-629-5220
Mailing address:
  • Phone: 207-629-5005
  • Fax: 207-629-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2004-01357
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: