Healthcare Provider Details

I. General information

NPI: 1306339056
Provider Name (Legal Business Name): DAVID Y ISSEVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 DOCTORS LN STE 202
CLARION PA
16214-8574
US

IV. Provider business mailing address

121 DOCTORS LN
CLARION PA
16214-8515
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-2500
  • Fax: 814-226-2501
Mailing address:
  • Phone: 814-226-3494
  • Fax: 814-226-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: