Provider Demographics
NPI:1063583243
Name:VANDERLYKE, DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:VANDERLYKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 RED LION RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1475
Mailing Address - Country:US
Mailing Address - Phone:215-673-7036
Mailing Address - Fax:
Practice Address - Street 1:842 RED LION RD
Practice Address - Street 2:SUITE 10
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1475
Practice Address - Country:US
Practice Address - Phone:215-673-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003874L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist