Provider Demographics
NPI:1336436302
Name:DAVILA, MYRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 EASTCHESTER RD
Mailing Address - Street 2:MEDICAL STAFF SUITE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2300
Mailing Address - Country:US
Mailing Address - Phone:718-518-2206
Mailing Address - Fax:
Practice Address - Street 1:1740 EASTCHESTER RD
Practice Address - Street 2:MEDICAL STAFF SUITE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2300
Practice Address - Country:US
Practice Address - Phone:718-518-2206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2016-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273778207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine