Provider Demographics
NPI:1134293855
Name:DAVISON, RITA (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:
Last Name:DAVISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 ERIE AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1656
Mailing Address - Country:US
Mailing Address - Phone:513-321-0199
Mailing Address - Fax:
Practice Address - Street 1:3330 ERIE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1656
Practice Address - Country:US
Practice Address - Phone:513-321-0199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063817208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0921373Medicaid