Provider Demographics
NPI:1386622967
Name:ELDRIDGE, DAVID MARCHANT (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARCHANT
Last Name:ELDRIDGE
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:JOHN CUMING BLDG
Mailing Address - Street 2:#840
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-371-7091
Mailing Address - Fax:978-371-2662
Practice Address - Street 1:JOHN CUMING BLDG
Practice Address - Street 2:#840
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-371-7091
Practice Address - Fax:978-371-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
JO6286Medicare PIN