Provider Demographics
NPI:1205917291
Name:DAVIS OCCUPATIONAL MEDICINE,P.C.
Entity type:Organization
Organization Name:DAVIS OCCUPATIONAL MEDICINE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-255-0778
Mailing Address - Street 1:200 PROVIDENCE HIGHWAY
Mailing Address - Street 2:SUITE 202-203
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-255-0778
Mailing Address - Fax:781-255-0857
Practice Address - Street 1:200 PROVIDENCE HIGHWAY
Practice Address - Street 2:SUITE 202-203
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-255-0778
Practice Address - Fax:781-255-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty