Provider Demographics
NPI:1083892046
Name:DAVIS, CHARLES TALCOTT II (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:TALCOTT
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 PARK AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2556
Mailing Address - Country:US
Mailing Address - Phone:212-685-0634
Mailing Address - Fax:212-213-1374
Practice Address - Street 1:77 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2556
Practice Address - Country:US
Practice Address - Phone:212-685-0634
Practice Address - Fax:212-213-1374
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1596592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry