Provider Demographics
NPI:1033326467
Name:DAVIS, NICHOLAS D (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2350 MIAMI VALLEY DR
Mailing Address - Street 2:SUITE 530
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4778
Mailing Address - Country:US
Mailing Address - Phone:937-435-3546
Mailing Address - Fax:937-435-3568
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:SUITE 530
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-435-3546
Practice Address - Fax:937-435-3568
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2013-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35092497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2954192Medicaid
OH2954192Medicaid