Healthcare Provider Details

I. General information

NPI: 1477932762
Provider Name (Legal Business Name): DAVID BAXTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E WOODLAND AVE SUITE 200
SPRINGFIELD PA
19064-3969
US

IV. Provider business mailing address

PO BOX 8500-6355
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-4490
  • Fax:
Mailing address:
  • Phone: 610-497-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS019893
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: