Provider Demographics
NPI:1336247261
Name:DAVIS, MARK PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILLIP
Last Name:DAVIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5501 BACKLICK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3933
Mailing Address - Country:US
Mailing Address - Phone:703-642-2273
Mailing Address - Fax:703-564-6544
Practice Address - Street 1:5501 BACKLICK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3933
Practice Address - Country:US
Practice Address - Phone:703-642-2273
Practice Address - Fax:703-564-6544
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101027333207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA206889Medicare ID - Type Unspecified