Provider Demographics
NPI:1912070889
Name:NUDELL, DAVID MARK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:NUDELL
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 1:2581 SAMARITAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-358-2030
Mailing Address - Fax:408-358-2036
Practice Address - Street 1:2581 SAMARITAN DRIVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-358-2030
Practice Address - Fax:408-358-2036
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60360208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrology
Not Answered2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A603601Medicare ID - Type Unspecified
H35173Medicare UPIN