Provider Demographics
NPI:1215978549
Name:FOX, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:FOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 W CHESTER PIKE
Mailing Address - Street 2:SUITE 300 MAIN LINE HEALTH CENTER
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2304
Mailing Address - Country:US
Mailing Address - Phone:484-427-8000
Mailing Address - Fax:484-427-8020
Practice Address - Street 1:3855 W CHESTER PIKE
Practice Address - Street 2:SUITE 300 MAIN LINE HEALTH CENTER
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:484-427-8000
Practice Address - Fax:484-427-8020
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD053646L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG08871Medicare UPIN
PA623613HK1Medicare PIN