Provider Demographics
NPI:1811186026
Name:STEPHEN V. DAVIS, M.D.,P.C.
Entity Type:Organization
Organization Name:STEPHEN V. DAVIS, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFC MGR/CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-799-0090
Mailing Address - Street 1:200 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2866
Mailing Address - Country:US
Mailing Address - Phone:434-799-0090
Mailing Address - Fax:434-799-0098
Practice Address - Street 1:200 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2866
Practice Address - Country:US
Practice Address - Phone:434-799-0090
Practice Address - Fax:434-799-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI01010382033207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA174610OtherANTHEM BLUE CROSS
C09417Medicare PIN
VA174610OtherANTHEM BLUE CROSS