Provider Demographics
NPI:1831490051
Name:DAVIS, ROBERT GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 ASHTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5701
Mailing Address - Country:US
Mailing Address - Phone:703-365-9085
Mailing Address - Fax:703-365-0269
Practice Address - Street 1:8140 ASHTON AVE STE 212
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5701
Practice Address - Country:US
Practice Address - Phone:703-365-9085
Practice Address - Fax:703-365-0269
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249187207L00000X
NY259172207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology