Provider Demographics
NPI:1922087485
Name:DAVIS, LEE W (DO)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:W
Last Name:DAVIS
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 1:407 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1061
Mailing Address - Country:US
Mailing Address - Phone:570-586-9500
Mailing Address - Fax:570-586-9485
Practice Address - Street 1:407 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1061
Practice Address - Country:US
Practice Address - Phone:570-586-9500
Practice Address - Fax:570-586-9485
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004835L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009667450004Medicaid
PA0009667450004Medicaid
PA425457Medicare PIN