Provider Demographics
NPI:1649968546
Name:DAVIS, ROMAINE TORRAY SR
Entity type:Individual
Prefix:MR
First Name:ROMAINE
Middle Name:TORRAY
Last Name:DAVIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4193 WESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1234
Mailing Address - Country:US
Mailing Address - Phone:216-203-5809
Mailing Address - Fax:
Practice Address - Street 1:4193 WESTBROOK DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-1234
Practice Address - Country:US
Practice Address - Phone:216-203-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide