Provider Demographics
NPI:1992753198
Name:MACBRIDE, DAVID GEORGE (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:MACBRIDE
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 1:7 LOWBRIDGE PSGE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3354
Mailing Address - Country:US
Mailing Address - Phone:609-654-6575
Mailing Address - Fax:
Practice Address - Street 1:1925 PACIFIC AVE
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6713
Practice Address - Country:US
Practice Address - Phone:609-441-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010151207PE0004X
NJMB080476207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60024445OtherHORIZON NJ HEALTH
NJ0111155Medicaid
NJ30037329OtherKEYSTONE MERCY
NJ2817667000OtherAMERIHEALTH
PA097666Medicare ID - Type Unspecified
NJ2817667000OtherAMERIHEALTH
NJ60024445OtherHORIZON NJ HEALTH
NJ0111155Medicaid
NJ30037329OtherKEYSTONE MERCY
NJP00759517Medicare PIN