Provider Demographics
NPI:1255301552
Name:DAVIS, PAUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:500 GROOVE STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-796-9397
Practice Address - Street 1:1 BRACE ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-470-9029
Practice Address - Fax:856-796-9391
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0006563208600000X
NJ25MA09009800208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
182454OtherCOVENTRY
DE1000016774Medicaid
E42406OtherBLUE SHIELD DE
DE1000016774Medicaid
NJ230684C04Medicare PIN