Provider Demographics
NPI:1669437513
Name:DAVIDSON, ERIC S (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
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 1:99 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-875-4811
Mailing Address - Fax:508-875-5942
Practice Address - Street 1:99 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-875-4811
Practice Address - Fax:508-875-5942
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222966207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA39018Medicare ID - Type Unspecified
MAI38814Medicare UPIN