Provider Demographics
NPI:1588651087
Name:DAVIES, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:DAVIES
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 1:800 S LOGAN BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3050
Mailing Address - Country:US
Mailing Address - Phone:814-944-2097
Mailing Address - Fax:814-941-2303
Practice Address - Street 1:800 S LOGAN BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3050
Practice Address - Country:US
Practice Address - Phone:814-944-2097
Practice Address - Fax:814-941-2303
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423645207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012399800001Medicaid
PA090951T8KMedicare ID - Type Unspecified
PA1012399800001Medicaid