Provider Demographics
NPI:1972597516
Name:DAVIS, HARRY A (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:A
Last Name:DAVIS
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:PO BOX 277
Mailing Address - Street 2:ELIZABETHTOWN COMMUNITY HOSPITAL
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932
Mailing Address - Country:US
Mailing Address - Phone:518-873-6377
Mailing Address - Fax:518-873-6578
Practice Address - Street 1:75 PARK ST
Practice Address - Street 2:ELIZABETHTOWN COMMUNITY HOSPITAL
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932
Practice Address - Country:US
Practice Address - Phone:518-873-6896
Practice Address - Fax:518-873-6578
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8075207PE0004X
NY1550291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354274Medicaid
NY00354274Medicaid
TX8D4019Medicare ID - Type Unspecified