Provider Demographics
NPI:1588610265
Name:DAVENPORT, NANCY J (MD, PHD, FACC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MD, PHD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 LOUGHBORO RD NW
Mailing Address - Street 2:SUITE 460
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2618
Mailing Address - Country:US
Mailing Address - Phone:202-686-9801
Mailing Address - Fax:202-363-6464
Practice Address - Street 1:5215 LOUGHBORO RD NW
Practice Address - Street 2:SUITE 460
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2618
Practice Address - Country:US
Practice Address - Phone:202-686-9801
Practice Address - Fax:202-363-6464
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18999207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC780000606OtherRR MEDICARE
MD205981900Medicaid
VA5823684Medicaid
DC025972100Medicaid
673206Medicare PIN
MD205981900Medicaid
DC296051ZBZ9Medicare PIN
DC780000606OtherRR MEDICARE
DCE90642Medicare UPIN