Provider Demographics
NPI:1851342760
Name:DAVIDSON, JAMES P (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-2100
Mailing Address - Country:US
Mailing Address - Phone:814-765-1521
Mailing Address - Fax:814-765-7756
Practice Address - Street 1:502 PARK AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2100
Practice Address - Country:US
Practice Address - Phone:814-765-1521
Practice Address - Fax:814-765-7756
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOSOO5O55L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010422200001Medicaid
PA024494Medicare ID - Type UnspecifiedMEDICARE NUMBER
PA0010422200001Medicaid
PA229441PLGMedicare PIN