Provider Demographics
NPI:1366490989
Name:DAVIS, RHONDA L (DPM)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1804
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-8304
Mailing Address - Country:US
Mailing Address - Phone:540-667-0130
Mailing Address - Fax:540-667-3893
Practice Address - Street 1:621 E JUBAL EARLY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5178
Practice Address - Country:US
Practice Address - Phone:540-667-0130
Practice Address - Fax:540-667-3893
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300962213ES0131X
WV10389213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4184121OtherMEDICARE PIN
WV4184121OtherMEDICARE PIN