Healthcare Provider Details

I. General information

NPI: 1073540076
Provider Name (Legal Business Name): DAVID A AXELROD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 S QUEEN ST
YORK PA
17403-4637
US

IV. Provider business mailing address

1620 S QUEEN ST
YORK PA
17403-4637
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-6663
  • Fax: 717-852-0670
Mailing address:
  • Phone: 717-843-6663
  • Fax: 717-852-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301035945
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number25MA08321700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD447274
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: