Provider Demographics
NPI:1578717187
Name:DAVIS, MICHAEL CHARLES (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 NEW HAMPSHIRE AVE.
Mailing Address - Street 2:BLDG 22, RM 4121
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20993
Mailing Address - Country:US
Mailing Address - Phone:301-796-0649
Mailing Address - Fax:888-202-1492
Practice Address - Street 1:10903 NEW HAMPSHIRE AVE.
Practice Address - Street 2:BLDG 22, RM 4121
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20993
Practice Address - Country:US
Practice Address - Phone:301-796-0649
Practice Address - Fax:888-202-1492
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD825232084P0800X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAET788YMedicare PIN