Provider Demographics
NPI:1477676807
Name:DAVIS, ORLANDO ROSS (MD)
Entity type:Individual
Prefix:
First Name:ORLANDO
Middle Name:ROSS
Last Name:DAVIS
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 1:201 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-8902
Mailing Address - Country:US
Mailing Address - Phone:410-963-7548
Mailing Address - Fax:410-764-9114
Practice Address - Street 1:2417 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2134
Practice Address - Country:US
Practice Address - Phone:410-963-7548
Practice Address - Fax:410-764-9114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4722392084P0800X
MDD00339672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD527911900Medicaid
MD486RMedicare ID - Type UnspecifiedMEDICARE NUMBER
MD527911900Medicaid