Healthcare Provider Details

I. General information

NPI: 1083617468
Provider Name (Legal Business Name): DAVID ACKROYD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 PROVIDENCE RD
SECANE PA
19018-2921
US

IV. Provider business mailing address

831 PROVIDENCE RD
SECANE PA
19018-2921
US

V. Phone/Fax

Practice location:
  • Phone: 610-622-7533
  • Fax: 610-622-7693
Mailing address:
  • Phone: 610-622-7533
  • Fax: 610-622-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-047071-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: