Provider Demographics
NPI:1437152113
Name:DAVIS, NEAL MALCOLM (DO)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:MALCOLM
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:254 BROOKLYN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1879
Mailing Address - Country:US
Mailing Address - Phone:570-282-3347
Mailing Address - Fax:570-282-2189
Practice Address - Street 1:254 BROOKLYN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1879
Practice Address - Country:US
Practice Address - Phone:570-282-3347
Practice Address - Fax:570-282-2189
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-006841-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA567939Medicare ID - Type Unspecified
E40981Medicare UPIN