Healthcare Provider Details

I. General information

NPI: 1205838968
Provider Name (Legal Business Name): DAVID WILLIAM LACEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR STE 302
FISHERSVILLE VA
22939-2273
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7400
  • Fax: 540-245-7401
Mailing address:
  • Phone: 540-932-5162
  • Fax: 540-932-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101267148
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2009-01893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: