Provider Demographics
NPI:1770509531
Name:DAVIS, ESA
Entity Type:Individual
Prefix:
First Name:ESA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MCKEE PL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 LOTHROP ST
Practice Address - Street 2:UPMC MONTEFIORE, 9 SOUTH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2536
Practice Address - Country:US
Practice Address - Phone:412-692-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438426207Q00000X
OH35083560207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2452126Medicaid
363466OtherWELLCARE
OHP00432281OtherRAILROAD MEDICARE
000000221367OtherUNISON
OH737674OtherBUCKEYE MEDICAID
OH000000319455OtherANTHEM
OHP00202469OtherRAILROAD MEDICARE
OH000000530387OtherANTHEM
OH7718415OtherAETNA
OHDA4120251Medicare PIN
OHP00432281OtherRAILROAD MEDICARE
OH2452126Medicaid