Provider Demographics
NPI:1619102050
Name:DAVIDSON, RISA DANIELLE (DO)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:DANIELLE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RISA
Other - Middle Name:DANIELLE
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12740 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7292
Mailing Address - Country:US
Mailing Address - Phone:317-343-8844
Mailing Address - Fax:540-274-8548
Practice Address - Street 1:12740 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7292
Practice Address - Country:US
Practice Address - Phone:317-343-8844
Practice Address - Fax:540-274-8548
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003938A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01456972OtherRR MEDICARE
IN201067930Medicaid
INP01456972OtherRR MEDICARE