Provider Demographics
NPI:1396776563
Name:ROBERT A DAVIS, MD FAMILY PRACTICE
Entity type:Organization
Organization Name:ROBERT A DAVIS, MD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-736-4850
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18917-0077
Mailing Address - Country:US
Mailing Address - Phone:152-429-0202
Mailing Address - Fax:215-249-3469
Practice Address - Street 1:145 N MAIN ST # 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:PA
Practice Address - Zip Code:18917-2107
Practice Address - Country:US
Practice Address - Phone:215-249-9020
Practice Address - Fax:215-249-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039330L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009959160011Medicaid