MEDICARE: DR. DAVID VANDERLYKE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	SC003874L	PA

General Provider Information

NPI Number	:	1063583243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID VANDERLYKE DPM

Provider Business Mailing Address
First Line	:	842 RED LION RD
Second Line	:	SUITE 10
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-1475
Country	:	US
Telephone Number	:	215-673-7036
Fax Number	:

Provider Business Practice Location Address
First Line	:	842 RED LION RD
Second Line	:	SUITE 10
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-1475
Country	:	US
Telephone Number	:	215-673-7036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	10/20/2016

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