Provider Demographics
NPI:1376572651
Name:DAVIS, GLORIA THAMARA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:THAMARA
Last Name:DAVIS
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 1:208 GOVERNOR ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3246
Mailing Address - Country:US
Mailing Address - Phone:401-663-5590
Mailing Address - Fax:
Practice Address - Street 1:208 GOVERNOR ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3246
Practice Address - Country:US
Practice Address - Phone:401-663-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD108522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry