Provider Demographics
NPI:1558341826
Name:DAVIS, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N MAIN ST
Mailing Address - Street 2:STE 204
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4349
Mailing Address - Country:US
Mailing Address - Phone:724-225-9970
Mailing Address - Fax:724-225-2990
Practice Address - Street 1:190 N MAIN ST
Practice Address - Street 2:STE 204
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4349
Practice Address - Country:US
Practice Address - Phone:724-225-9970
Practice Address - Fax:724-225-2990
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021236E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097290Medicare PIN
C29822Medicare UPIN