Healthcare Provider Details

I. General information

NPI: 1548208770
Provider Name (Legal Business Name): DAVID M PUDLES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 TYSON AVE
PHILADELPHIA PA
19149-1415
US

IV. Provider business mailing address

2831 TYSON AVE
PHILADELPHIA PA
19149-1415
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-2487
  • Fax: 215-624-0874
Mailing address:
  • Phone: 215-624-2487
  • Fax: 215-624-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS005343L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: