Provider Demographics
NPI:1538133145
Name:DAVIS, DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN298864L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050051233OtherRR MEDICARE
PA7019740OtherAETNA-NON HMO
PA3741OtherGEISINGER
PA50055753OtherCAPITAL BLUE CROSS & KEYSTONE HEALTH PLAN CENTRAL
PA1147557OtherAETNA-HMO
PA2066301000OtherINDEPENDENCE BLUE CROSS
PA001373990OtherHIGHMARK
PA2066301000OtherINDEPENDENCE BLUE CROSS