Provider Demographics
NPI:1871819797
Name:DAVIS, TROY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:A
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 1:1941 BISHOP LN STE 1018
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-456-6211
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1220 MISSOURI AVE
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3725
Practice Address - Country:US
Practice Address - Phone:502-456-6212
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076475A207ZP0102X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201361220AMedicaid
KY7100167180Medicaid
KY50110088OtherPASSPORT
INP01818955OtherMEDICARE RR
KY000000999127OtherANTHEM
IN201361220AMedicaid