Provider Demographics
NPI:1861491649
Name:DAVISON, MARIA W (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:W
Last Name:DAVISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16, LL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:HAMOT EMERGENCY ROOM
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6139
Practice Address - Fax:814-877-6093
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD071114L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025502201OtherUNIVERA
PA0018065770001Medicaid
PA1514335OtherGATEWAY
NY02088062OtherNY MEDICAL ASSISTANCE
PA707942OtherBLUE SHIELD
WV1068743OtherWEST VIRGINIA WORK COMP
PA212518OtherUPMC
PA930094341OtherRR MEDICARE
OH2217630OtherOH MEDICAL ASSISTANCE
PA2546394OtherAETNA
PA107874OtherUNISON
PA212518OtherUPMC
PA707942OtherBLUE SHIELD