Provider Demographics
NPI:1922133842
Name:DAVIS, JOHN E (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-337-7772
Mailing Address - Fax:410-337-8729
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 215
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-337-7772
Practice Address - Fax:410-337-8729
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS601OtherPROVIDER NUMBER