Provider Demographics
NPI:1629110788
Name:DAVIS, KISHA N (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHA
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KISHA
Other - Middle Name:N
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 KNOLL NORTH DR
Mailing Address - Street 2:SUITE 370
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2209
Mailing Address - Country:US
Mailing Address - Phone:410-884-7831
Mailing Address - Fax:410-715-3734
Practice Address - Street 1:5500 KNOLL NORTH DR
Practice Address - Street 2:SUITE 370
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2209
Practice Address - Country:US
Practice Address - Phone:410-884-7831
Practice Address - Fax:410-715-3734
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD65224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine