Provider Demographics
NPI:1740598804
Name:DAVIS, MARK JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JEFFREY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8918 TONBRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2052
Mailing Address - Country:US
Mailing Address - Phone:301-434-3709
Mailing Address - Fax:
Practice Address - Street 1:2120 L ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1527
Practice Address - Country:US
Practice Address - Phone:202-741-2261
Practice Address - Fax:202-741-2921
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA049949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E2221Medicare UPIN