MEDICARE: DR. DAVID ISRAEL PHD

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	103TB0200X	Cognitive & Behavioral Psychologist	0810000634	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861404881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ISRAEL PHD

Provider Business Mailing Address
First Line	:	2120 STAPLES MILL RD
Second Line	:	STE 209
City	:	RICHMOND
State	:	VA
Zip	:	23230-2917
Country	:	US
Telephone Number	:	804-288-1308
Fax Number	:	804-288-1058

Provider Business Practice Location Address
First Line	:	2120 STAPLES MILL RD
Second Line	:	STE 209
City	:	RICHMOND
State	:	VA
Zip	:	23230-2917
Country	:	US
Telephone Number	:	804-716-2629
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	11/02/2018

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