Provider Demographics
NPI:1588654297
Name:DAVIS, IRIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1928 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6611
Mailing Address - Country:US
Mailing Address - Phone:910-338-9566
Mailing Address - Fax:888-975-7834
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:#200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:443-844-5986
Practice Address - Fax:888-975-7834
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2014-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD44854207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE97240Medicare UPIN