Provider Demographics
NPI:1023105822
Name:DAVIS, EILEEN MARY (DO)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947
Mailing Address - Country:US
Mailing Address - Phone:302-856-2254
Mailing Address - Fax:302-856-2330
Practice Address - Street 1:201 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947
Practice Address - Country:US
Practice Address - Phone:302-856-2254
Practice Address - Fax:302-856-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0006045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C2-0006045OtherLICENSE
DE0001044304Medicaid
DE0001044304Medicaid
DEG00438Medicare ID - Type Unspecified