Provider Demographics
NPI:1902894124
Name:FUNK, DAVID R (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:FUNK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6224
Mailing Address - Country:US
Mailing Address - Phone:610-866-9311
Mailing Address - Fax:610-882-2072
Practice Address - Street 1:264 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6224
Practice Address - Country:US
Practice Address - Phone:610-866-9311
Practice Address - Fax:610-882-2072
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006886L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA680012420OtherRAIL ROAD MEDICARE
PA276935000OtherMAGELLAN BEHAVIORAL HEALT
PA7497155OtherAETNA
PA02056702OtherCAPITAL BLUE CROSS
PA0523970000OtherINDEPENDENCE BLUE CROSS
PA708295OtherHIGHMARK
PA7497155OtherAETNA