Provider Demographics
NPI:1376679936
Name:IRA DAVIS, MD, PLLC
Entity Type:Organization
Organization Name:IRA DAVIS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-288-0500
Mailing Address - Street 1:280 N CENTRAL AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1832
Mailing Address - Country:US
Mailing Address - Phone:914-288-0500
Mailing Address - Fax:914-288-0260
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1832
Practice Address - Country:US
Practice Address - Phone:914-288-0500
Practice Address - Fax:914-288-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182268207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2K9111OtherWEST BLUECROSS
P00221021OtherRR MCR
NYOH4223OtherHEALTHNET
NYP2869871OtherOXFORD
NYE86323Medicare UPIN
NY82F471Medicare PIN
NY2K9111OtherWEST BLUECROSS