Healthcare Provider Details

I. General information

NPI: 1942218540
Provider Name (Legal Business Name): MARIA C DAVID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA C GONZALES MD

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 NORTH ST SUITE A
NEWBURGH NY
12550
US

IV. Provider business mailing address

266 NORTH ST STE A
NEWBURGH NY
12550-3131
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-5437
  • Fax: 845-565-7021
Mailing address:
  • Phone: 845-565-5437
  • Fax: 845-565-7021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2050421
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034908
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: