Provider Demographics
NPI:1124095443
Name:PEISNER, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:PEISNER
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 1:869 BEAVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801
Mailing Address - Country:US
Mailing Address - Phone:814-371-6501
Mailing Address - Fax:814-371-6504
Practice Address - Street 1:869 BEAVER DRIVE
Practice Address - Street 2:
Practice Address - City:DUBOIS
Practice Address - State:PA
Practice Address - Zip Code:15801
Practice Address - Country:US
Practice Address - Phone:814-371-6501
Practice Address - Fax:814-371-6504
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433961207VM0101X
MO2018040330207VM0101X
DCMD040155207VM0101X
MDD72661207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD433961OtherSTATE MEDICAL LICENSE
PA1021144330001Medicaid
PA102114433Medicaid
PA1021144330001Medicaid
PAMD433961OtherSTATE MEDICAL LICENSE
PA125605Medicare PIN