Provider Demographics
NPI:1063402832
Name:DERRICK, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DERRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:YORK HOSPITAL
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-5001
Practice Address - Fax:717-851-5114
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047321L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079119OtherHIGHMARK BLUE SHIELD YH
PA001576397Medicaid
PA30147692OtherAMERIHEALTH CARITAS-GH
PA50067275OtherCAPITAL BLUE CROSS YH
PA30124646OtherAMERIHEALTH MERCY - WSRH
PA55051OtherGEISINGER YH
PA0123091000OtherAMERIHEALTH 65 PA-YH
PA1140821OtherAMERIHEALTH MERCY-YH
PA1537591OtherGATEWAY YH
PA079119EZ3Medicare PIN
PA1140821OtherAMERIHEALTH MERCY-YH
PA001576397Medicaid
PA1537591OtherGATEWAY YH