Provider Demographics
NPI:1932304326
Name:DAVIS, MARY MARGARET (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARGARET
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4700 N ROAD 500 W
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-9755
Mailing Address - Country:US
Mailing Address - Phone:317-422-8225
Mailing Address - Fax:317-423-5696
Practice Address - Street 1:2560 N SHADELAND AVE STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1706
Practice Address - Country:US
Practice Address - Phone:317-275-8000
Practice Address - Fax:317-423-5696
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043350A207ZP0213X, 207SC0300X, 207ZP0102X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Not Answered207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Not Answered209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING72693Medicare UPIN