Provider Demographics
NPI:1104847789
Name:DAVIDSON, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:THE WANAMAKER BUILDING 9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9538
Mailing Address - Fax:267-425-9552
Practice Address - Street 1:34TH & CIVIC CENTER BLVD
Practice Address - Street 2:CHILDREN'S HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-1527
Practice Address - Fax:215-590-1501
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026953E207X00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000860890Medicaid
NJ556301Medicaid
PA091030Medicare ID - Type Unspecified
PA000860890Medicaid