Healthcare Provider Details

I. General information

NPI: 1487649299
Provider Name (Legal Business Name): DAVID LEE TROUTMAN JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GRAMPIAN BLVD STE 2F
WILLIAMSPORT PA
17701-1965
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-321-2020
  • Fax: 570-320-7599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC004396L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC004396L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: