Healthcare Provider Details

I. General information

NPI: 1326206483
Provider Name (Legal Business Name): DAVID THOMAS OGUREK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 N 1ST ST
LEHIGHTON PA
18235-1450
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 484-464-9510
  • Fax:
Mailing address:
  • Phone: 215-707-2400
  • Fax: 215-707-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD441063
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: