MEDICARE: DR. DAVID PAUL DEYSHER D.O.

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	207RG0100X	Gastroenterology Physician	OS005373L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	105170	OTHER	HIGHMARK BLUE SHIELD
2	01554001	OTHER	CAPITAL BLUE CROSS
3	1512967	OTHER	GATEWAY HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164414678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL DEYSHER D.O.

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-376-1180
Fax Number	:	717-273-6937

Provider Business Practice Location Address
First Line	:	954 ISABEL DR
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7482
Country	:	US
Telephone Number	:	717-376-1180
Fax Number	:	717-273-6937

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	01/02/2018

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