Provider Demographics
NPI:1942259742
Name:VANDERBURGH, DAVID F (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:VANDERBURGH
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 1:1908 COOLIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419
Mailing Address - Country:US
Mailing Address - Phone:937-657-8288
Mailing Address - Fax:937-299-3875
Practice Address - Street 1:1908 COOLIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419
Practice Address - Country:US
Practice Address - Phone:937-657-8288
Practice Address - Fax:937-299-3875
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350781332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2198894Medicaid
OHVA4034028Medicare PIN
OH2198894Medicaid