DAVID T SUPERDOCK (NPI# 1326023045) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326023045 |
| Entity Type | Individual |
| Full Name | DAVID T SUPERDOCK |
| Credential | M.D. |
| Practice Address |
562 W 2nd Ave Lititz PA 17543-1816 |
| Practice Telephone | 7176262167 |
| Practice Fax Number | 7176261915 |
| Mailing Telephone | 7176262167 |
| Mailing Fax Number | 7176261915 |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2007-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD041940L | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0012090930001 | 05 | |
| PA | CAPITAL BLUE CROSS | 01971402 | 01 |
| PA | GEISINGER HEALTH PLAN | 37716 S1QG | 01 |
| PA | GATEWAY HEALTH PLAN | P002303 | 01 |
| PA | HIGHMARK BLUE SHIELD | 615224 | 01 |
| PA | HEALTH ASSURANCE | E23590 | 01 |
| PA | AETNA NON-HMO | 5659089 | 01 |
| PA | AETNA HMO | 578406 | 01 |
| Street Address |
562 W 2ND AVE |
| City | LITITZ |
| State | PA |
| Zip Code | 17543-1816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073597134 | Thomas W Andersen | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2005-12-02 |
| 1740718212 | Daniel Alexander Russo | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2017-05-30 |
| 1639552797 | Sarah Sell | Nurse Practitioner | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2015-07-07 |
| 1508202367 | Sara A Schuch | Counselor | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2013-05-20 |
| 1649576000 | Carly M Meyer | Nurse Practitioner | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2011-02-02 |
| 1780651364 | Shirley B Terenchin | Nurse Practitioner | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2006-03-02 |
| 1851376685 | Dale W Sailer | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2005-12-14 |
| 1598740615 | Gary J Scibal | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2005-12-12 |
| 1427033927 | Marc S Russo | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2005-12-07 |
| 1447234521 | Mary E Ivy | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2005-12-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205306883 | Lauren Sue Topper | Pharmacist | 740 South Broad Street, Lititz, PA 17543 | 2018-11-27 |
| 1710478540 | Lancaster General Medical Group | Family Medicine | 51 Peters Rd Ste 101, Lititz, PA 17543 | 2018-05-29 |
| 1679062350 | Saima Sarmin Mukta | Family Medicine | Upmc Pinnacle Lititz, 1500 Highlands Dr, Lititz, PA 17543 | 2018-05-08 |
| 1073027488 | Bradford Todd Nicarry | Massage Therapist | 901 Rothsville Rd, Lititz, PA 17543 | 2017-11-21 |
| 1962929539 | Megan Sham | Occupational Therapist | 206 Starflower Vw, Lititz, PA 17543 | 2017-08-24 |
| 1124566815 | Stephanie Schultheisz | Speech-Language Pathologist | 58 E Center St, Lititz, PA 17543 | 2017-02-02 |
| 1720323975 | Gregory Robert James O'neill | Chiropractor | 766 Lititz Pike, Lititz, PA 17543 | 2012-11-29 |
| 1508132234 | J. Cornack Therapy Group LLC | Early Intervention Provider Agency | 604 Cournthouse Cir, Lititz, PA 17543 | 2012-03-27 |
| 1124338793 | T. W. Ponessa and Associates Counseling Services, Inc. | Community/Behavioral Health | 1001 Buckwalter Road, Lititz, PA 17543 | 2010-10-18 |
| 1518289420 | Pamela Lynn Noden | Counselor | 2320 Rothsville Rd Ste 103a, Lititz, PA 17543 | 2010-02-18 |
| Find all providers in zip 17543 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699383430 | Lancaster General Medical Group | Family Medicine | 26 N Cedar St, Lititz, PA 17543-1514 | 2020-07-17 |
| 1710478540 | Lancaster General Medical Group | Family Medicine | 51 Peters Rd Ste 101, Lititz, PA 17543 | 2018-05-29 |
| 1679062350 | Saima Sarmin Mukta | Family Medicine | Upmc Pinnacle Lititz, 1500 Highlands Dr, Lititz, PA 17543 | 2018-05-08 |
| 1447544242 | Jennifer M Payne | Family Medicine | 51 Peters Rd, Suite 200, Lititz, PA 17543-7685 | 2011-06-09 |
| 1912207614 | David William Frederick | Family Medicine | 726 Buckwood Ln, Lititz, PA 17543-8632 | 2010-10-27 |
| 1538380126 | Dwight Alvin Herr | Family Medicine | 6 West Newport Road, Lititz, PA 17543 | 2007-05-01 |
| 1750325189 | Northern Lancaster County Medical Group | Family Medicine | 2320 Rothsville Rd, Suite 200, Lititz, PA 17543-8215 | 2006-06-15 |
| 1548201700 | Louise R Butler | Family Medicine | 1535 Highlands Dr Ste 100, Lititz, PA 17543-7681 | 2006-06-09 |
| 1073597134 | Thomas W Andersen | Family Medicine | 562 W 2nd Ave, Lititz, PA 17543-1816 | 2005-12-02 |
| 1164405593 | Lancaster General Medical Group | Family Medicine | 562 West 2nd Avenue, Lititz, PA 17543-1816 | 2005-11-21 |
| Find all providers in LITITZ | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.