Provider Demographics
NPI:1962581538
Name:VIRSHUP, DAVID MARC (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARC
Last Name:VIRSHUP
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 1:14525 SW MILLIKAN WAY
Mailing Address - Street 2:PMB 41724
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2343
Mailing Address - Country:US
Mailing Address - Phone:801-542-9414
Mailing Address - Fax:
Practice Address - Street 1:8 COLLEGE ROAD
Practice Address - Street 2:
Practice Address - City:SINGAPORE
Practice Address - State:SINGAPORE
Practice Address - Zip Code:169857
Practice Address - Country:SG
Practice Address - Phone:656-516-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183783-12052080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology