Provider Demographics
NPI:1437193448
Name:ROBERT J DAVIS, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT J DAVIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-543-8880
Mailing Address - Street 1:1344 S DIVISION ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6921
Mailing Address - Country:US
Mailing Address - Phone:410-543-8880
Mailing Address - Fax:410-749-4426
Practice Address - Street 1:1344 S DIVISION ST
Practice Address - Street 2:STE 202
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6921
Practice Address - Country:US
Practice Address - Phone:410-543-8880
Practice Address - Fax:410-749-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77604Medicare UPIN
MDI07162Medicare UPIN