Provider Demographics
NPI:1568484780
Name:DAVIS, CHRISTOPHER JOHN (MD, MPH, MBA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD, MPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 ASHBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1704
Mailing Address - Country:US
Mailing Address - Phone:585-738-9535
Mailing Address - Fax:585-442-8494
Practice Address - Street 1:296 ASHBOURNE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-1704
Practice Address - Country:US
Practice Address - Phone:585-738-9535
Practice Address - Fax:585-442-8494
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145320208D00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420795Medicaid
NY01420800Medicaid