Provider Demographics
NPI:1154307569
Name:VANCHURE, DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:VANCHURE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOSPITAL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1464
Mailing Address - Country:US
Mailing Address - Phone:814-299-7432
Mailing Address - Fax:814-299-7434
Practice Address - Street 1:145 HOSPITAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1464
Practice Address - Country:US
Practice Address - Phone:814-299-7432
Practice Address - Fax:814-299-7434
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002654363A00000X
LAPA.200031363AS0400X
PAMA050819363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP59733Medicare UPIN
LAP59733Medicare UPIN
PA133303Medicare PIN
PA133303Medicare PIN