Provider Demographics
NPI:1861456725
Name:DAVIS, EDWARD T (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:ENROLLMENT CENTER
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:3213 NAZARETH RD
Practice Address - Street 2:
Practice Address - City:PALMER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18045-2000
Practice Address - Country:US
Practice Address - Phone:610-559-2060
Practice Address - Fax:610-559-2064
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD425243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011851330002Medicaid
PA091029Medicare ID - Type UnspecifiedMEDICARE
PAC59361Medicare UPIN