Provider Demographics
NPI:1801822630
Name:DAVIS, RAE J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD EXECUTIVE PLAZA 1
Mailing Address - Street 2:STE. 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:703-738-4331
Mailing Address - Fax:703-560-8214
Practice Address - Street 1:19500 SANDRIDGE WAY
Practice Address - Street 2:STE 100
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-3688
Practice Address - Country:US
Practice Address - Phone:703-738-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246574208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494486OtherTUFTS
MAA38731Medicare ID - Type Unspecified
I34049Medicare UPIN
MA37001OtherHEALTH NEW ENGLAND
MAJ29455OtherBCBS
MAAA40719OtherHARVARD PILGRIM
MA2108089Medicaid