Provider Demographics
NPI:1801821491
Name:DAVIS, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:145 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18917-2107
Mailing Address - Country:US
Mailing Address - Phone:215-249-9020
Mailing Address - Fax:215-249-3469
Practice Address - Street 1:145 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:PA
Practice Address - Zip Code:18917-2107
Practice Address - Country:US
Practice Address - Phone:215-249-9020
Practice Address - Fax:215-249-3469
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039330L207Q00000X
PAMD039330-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C34401Medicare UPIN
PA463036Medicare PIN