MEDICARE: MR. ISMAEL V. DAVID M.D.

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	207R00000X	Internal Medicine Physician	111843-1	NY

General Provider Information

NPI Number	:	1124395140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISMAEL V. DAVID M.D.

Provider Business Mailing Address
First Line	:	6 ANCHORAGE RD
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1051
Country	:	US
Telephone Number	:	631-331-4887
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 ANCHORAGE RD
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1051
Country	:	US
Telephone Number	:	631-331-4887
Fax Number	:

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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