=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720248289
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID PELEG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 02/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 159 INTERSTATE PKWY WOMEN'S HEALTH SERVICES
-----------------------------------------------------
City | BRADFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16701-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-362-8480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 159 INTERSTATE PKWY WOMEN'S HEALTH SERVICES
-----------------------------------------------------
City | BRADFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16701-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-362-8480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD22825
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD432865
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------