Provider Demographics
NPI:1861404881
Name:ISRAEL, DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ISRAEL
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 1:2120 STAPLES MILL RD
Mailing Address - Street 2:STE 209
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2917
Mailing Address - Country:US
Mailing Address - Phone:804-288-1308
Mailing Address - Fax:804-288-1058
Practice Address - Street 1:2120 STAPLES MILL RD
Practice Address - Street 2:STE 209
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2917
Practice Address - Country:US
Practice Address - Phone:804-716-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000634103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7708271Medicaid
VA620000107Medicare ID - Type Unspecified