Provider Demographics
NPI:1609872993
Name:DAVIDSON, GARY M (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8109 HINSON FARM RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3415
Mailing Address - Country:US
Mailing Address - Phone:703-780-2800
Mailing Address - Fax:703-780-0461
Practice Address - Street 1:8109 HINSON FARM RD
Practice Address - Street 2:SUITE 504
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3415
Practice Address - Country:US
Practice Address - Phone:703-780-2800
Practice Address - Fax:703-780-0461
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101250753207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1163593Medicaid
PA1163593Medicaid
E52806Medicare UPIN
VA444015Medicare PIN