Provider Demographics
NPI:1386688935
Name:SEVITSKI, DAVID J (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SEVITSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 COTTMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1421
Mailing Address - Country:US
Mailing Address - Phone:215-332-9666
Mailing Address - Fax:215-332-1436
Practice Address - Street 1:2813 COTTMAN AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1421
Practice Address - Country:US
Practice Address - Phone:215-332-9666
Practice Address - Fax:215-332-1436
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005347L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0058527000OtherKEYSTONE PROVIDER NUMBER
PA4076253OtherAETNA PROVIDER NUMBER
PA4076253OtherAETNA PROVIDER NUMBER
PAF33473Medicare UPIN