Provider Demographics
NPI:1578525051
Name:DAVIS, ROBERT FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FREDERICK
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 1:8 PROSPECT ST
Mailing Address - Street 2:NORTH 1
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3925
Mailing Address - Country:US
Mailing Address - Phone:603-577-2663
Mailing Address - Fax:603-577-3366
Practice Address - Street 1:8 PROSPECT ST
Practice Address - Street 2:NORTH 1
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3925
Practice Address - Country:US
Practice Address - Phone:603-577-2663
Practice Address - Fax:603-577-3366
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10418207X00000X, 207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50080215OtherBLUE CROSS
PA1022104490001Medicaid
PA50080215OtherBLUE CROSS
PA143029FCQMedicare PIN