Provider Demographics
NPI:1275522799
Name:DAVIS, DEBORAH (CRNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:TOPPING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:124 N MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1045
Mailing Address - Country:US
Mailing Address - Phone:410-641-9450
Mailing Address - Fax:410-641-9515
Practice Address - Street 1:9714 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1154
Practice Address - Country:US
Practice Address - Phone:410-641-4430
Practice Address - Fax:410-641-4431
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR046708363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKP95297UMedicare ID - Type Unspecified
MDS42653Medicare UPIN