Provider Demographics
NPI:1508852849
Name:DAVIS, KIRK W (DPM)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3805
Mailing Address - Country:US
Mailing Address - Phone:717-267-2255
Mailing Address - Fax:717-262-6385
Practice Address - Street 1:601 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3805
Practice Address - Country:US
Practice Address - Phone:717-267-2255
Practice Address - Fax:717-262-6385
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002071L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001650028Medicaid
PAT28790Medicare UPIN
PA001650028Medicaid