Provider Demographics
NPI:1700827920
Name:DAVY, EDWIN GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:GILBERT
Last Name:DAVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1814
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43307-1814
Mailing Address - Country:US
Mailing Address - Phone:740-383-7847
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43301-1814
Practice Address - Country:US
Practice Address - Phone:740-383-7000
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031752D2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000141633OtherANTHEM
OH0511137Medicaid
0527468OtherPALMETTO MEDICARE
311098079249OtherMEDICAL MUTUAL
353079OtherSUBMITTER NO.
341893458005OtherMEDICAL MUTUAL
4486261OtherAETNA
1601314OtherUHC
0527463OtherPALMETTO MEDICARE
OH0511137Medicaid
0527468OtherPALMETTO MEDICARE