Provider Demographics
NPI:1013957729
Name:DAVIS, WILLIAM FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FREDERICK
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 1:1839 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2121
Mailing Address - Country:US
Mailing Address - Phone:570-251-6500
Mailing Address - Fax:570-253-8174
Practice Address - Street 1:1839 FAIR AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2121
Practice Address - Country:US
Practice Address - Phone:570-251-6500
Practice Address - Fax:570-253-8174
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029754E207Q00000X
NY108469-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004964601OtherHEALTH NOW ID NUMBER
PA18209OtherGEISINGER HEALTH PLAN ID
PA000928379Medicaid
PA002309OtherFIRST PRIORITY HEALTH ID
NY00916849Medicaid
NY004964601OtherHEALTH NOW ID NUMBER
PA000928379Medicaid
C30982Medicare UPIN
PA126880Medicare ID - Type Unspecified
NY9X6641Medicare ID - Type Unspecified