Provider Demographics
NPI:1033693320
Name:DAVIS, MARLA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:107-491-0154
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:100 POWER ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6940
Practice Address - Country:US
Practice Address - Phone:410-543-2060
Practice Address - Fax:410-543-2051
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid