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General NPI Number Information
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NPI Number | 1043496326
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Entity Type | Organization
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Legal Business Name | DAVID S VANDERLYKE D P M
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 842 RED LION RD STE 10
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1475
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Country | US
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Telephone | 215-673-7036
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Fax | 215-673-9670
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Provider Business Mailing Address
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Address Line | 842 RED LION RD STE 10
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1475
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Country | US
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Telephone | 215-673-7036
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Fax | 215-673-9670
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Authorized Official
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Title or Position | DPM
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Name | DAVID S VANDERLYKE
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Credential | D P M
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Telephone | 215-673-7036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SCOO3874L
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License Number State | PA
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