Provider Demographics
NPI:1457390742
Name:DAVIDSON, ERIC N (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:N
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EXECUTIVE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4155
Mailing Address - Country:US
Mailing Address - Phone:434-791-1345
Mailing Address - Fax:
Practice Address - Street 1:125 EXECUTIVE DR
Practice Address - Street 2:SUITE H
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4155
Practice Address - Country:US
Practice Address - Phone:434-791-1345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8905390Medicaid
VA006095372Medicaid
VA012791OtherANTHEM
NC8905390Medicaid
B09817Medicare UPIN