Provider Demographics
NPI:1164459178
Name:DAVIDSON, MARK MEHRDAD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MEHRDAD
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7487
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-7487
Mailing Address - Country:US
Mailing Address - Phone:310-855-0222
Mailing Address - Fax:310-652-1905
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:1135-E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-855-0222
Practice Address - Fax:310-652-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA67586207R00000X, 207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology