Provider Demographics
NPI:1942209549
Name:DAVIDSON, ROBERT SCOT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOT
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LYON PLACE
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-713-5300
Mailing Address - Fax:866-506-5573
Practice Address - Street 1:3 LYON PLACE
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-713-5300
Practice Address - Fax:866-506-5573
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217141208600000X
FLME85644208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG85534Medicare UPIN
FL51444ZMedicare PIN