Provider Demographics
NPI:1518197763
Name:MARK E. DAVIOSN DPM
Entity Type:Organization
Organization Name:MARK E. DAVIOSN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-237-2204
Mailing Address - Street 1:315 S ALLEN ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4849
Mailing Address - Country:US
Mailing Address - Phone:814-237-2204
Mailing Address - Fax:814-237-9611
Practice Address - Street 1:315 S ALLEN ST
Practice Address - Street 2:SUITE 118
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4849
Practice Address - Country:US
Practice Address - Phone:814-237-2204
Practice Address - Fax:814-237-9611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty