Individual
DAVID T SUPERDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
562 W 2ND AVE, LITITZ, PA 17543-1816
(717) 626-2167
(717) 626-1915
Mailing address
562 W 2ND AVE, LITITZ, PA 17543-1816
(717) 626-2167
(717) 626-1915
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD041940L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012090930001
—
PA
01
—
01971402
CAPITAL BLUE CROSS
PA
01
—
37716 S1QG
GEISINGER HEALTH PLAN
PA
01
—
5659089
AETNA NON-HMO
PA
01
—
578406
AETNA HMO
PA
01
—
615224
HIGHMARK BLUE SHIELD
PA
01
—
E23590
HEALTH ASSURANCE
PA
01
—
P002303
GATEWAY HEALTH PLAN
PA
Enumeration date
12/15/2005
Last updated
09/01/2007
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