Provider Demographics
NPI:1841387925
Name:DAVIS, JUHAYNA KASSEM (MD)
Entity Type:Individual
Prefix:
First Name:JUHAYNA
Middle Name:KASSEM
Last Name:DAVIS
Suffix:
Gender:F
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:PO BOX 419430
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9430
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-483-2242
Practice Address - Street 1:311 BAY AVE
Practice Address - Street 2:MMG PULMONOLOGY
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028
Practice Address - Country:US
Practice Address - Phone:973-433-7034
Practice Address - Fax:973-433-7324
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07923400207RP1001X
NC2007-01717207RC0200X, 207RP1001X
NY221401207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841387925Medicaid
NC5911171Medicaid
SCN17000Medicaid
NC2023452Medicare PIN
NC1841387925Medicaid
SCN17000Medicaid