Provider Demographics
NPI:1821393620
Name:DAVIS, CAROL DENISE (DO, MSPH)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BELL AVENUE
Mailing Address - Street 2:BLDGE 490 OMC BNL
Mailing Address - City:UPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11973
Mailing Address - Country:US
Mailing Address - Phone:631-344-3760
Mailing Address - Fax:
Practice Address - Street 1:30 BELL AVENUE
Practice Address - Street 2:BLDGE 490 OMC BROOKHAVEN NATIONAL LABORATORY
Practice Address - City:UPTON
Practice Address - State:NY
Practice Address - Zip Code:11973
Practice Address - Country:US
Practice Address - Phone:631-344-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1939822083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine