Provider Demographics
NPI:1063247641
Name:PACK, DAVID R
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:PACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 STACY LEE CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-9421
Mailing Address - Country:US
Mailing Address - Phone:443-244-2095
Mailing Address - Fax:
Practice Address - Street 1:418 STACY LEE CT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-9421
Practice Address - Country:US
Practice Address - Phone:443-244-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst