Provider Demographics
NPI:1437160546
Name:DAVIS, REGINA DENISE (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3960 TURNPIKE ROAD
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER VICTORY, LLC
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701
Mailing Address - Country:US
Mailing Address - Phone:757-393-1136
Mailing Address - Fax:757-393-5534
Practice Address - Street 1:3960 TURNPIKE ROAD
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER VICTORY, LLC
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-393-5534
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005630339Medicaid
VA080006911Medicare ID - Type Unspecified
VAD67367Medicare UPIN