Provider Demographics
NPI:1629170154
Name:DAVIS, RESA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RESA
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:44075 PIPELINE PLZ
Mailing Address - Street 2:SUITE#210
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5881
Mailing Address - Country:US
Mailing Address - Phone:703-858-0121
Mailing Address - Fax:703-858-0710
Practice Address - Street 1:44075 PIPELINE PLZ
Practice Address - Street 2:SUITE#210
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5881
Practice Address - Country:US
Practice Address - Phone:703-858-0121
Practice Address - Fax:703-858-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101234951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100880Medicare UPIN