Provider Demographics
NPI:1043281850
Name:LLEWELLYN, DAVID MARK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK EDWARD
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MERCY CIRCLE
Mailing Address - Street 2:NHCP INTERNAL MEDICINE
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-719-3682
Mailing Address - Fax:760-725-1690
Practice Address - Street 1:200 MERCY CIRCLE
Practice Address - Street 2:NHCP INTERNAL MEDICINE
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:928-649-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG1446032084N0400X
CAG1436032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ790956Medicaid
AZ790956Medicaid