Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003874L | PA |
Y | 222Z00000X | Podiatrist | SC003874L | PA |
NPI | 1063583243 |
---|---|
Provider Name | Dr. David Vanderlyke |
First Address | Philadelphia, PA 19115-1475 |
Second Address | Philadelphia, PA 19115-1475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 20/10/2016 |