Superdock, David T

Superdock, David T is an individual health care provider with primary practice located at 562 W 2Nd Ave , Lititz PA 17543-1816. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Superdock, David T can be contacted via phone (717) 626-2167.

Contact Information

Primary practice address
562 W 2Nd Ave Lititz PA 17543-1816
Phone: (717) 626-2167
Fax: (717) 626-1915
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD041940L Pennsylvania

Profile Details

NPI number 1326023045
LBN Legal business name Superdock, David T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 15th, 2005
Last updated Sep 1st, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326023045 NPPES
Pennsylvania Other 01971402 CAPITAL BLUE CROSS
Pennsylvania Other 578406 CAPITAL BLUE CROSS
Pennsylvania Other 615224 CAPITAL BLUE CROSS
Pennsylvania Other E23590 CAPITAL BLUE CROSS
Pennsylvania Other P002303 CAPITAL BLUE CROSS
Pennsylvania Other 37716 S1QG CAPITAL BLUE CROSS
Pennsylvania Other 5659089 CAPITAL BLUE CROSS
Pennsylvania MEDICAID 0012090930001 CAPITAL BLUE CROSS

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