Provider Demographics
NPI:1720142425
Name:DAVIS, UMAR M
Entity Type:Individual
Prefix:
First Name:UMAR
Middle Name:M
Last Name:DAVIS
Suffix:
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 1:31 WENARK DR APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1437
Mailing Address - Country:US
Mailing Address - Phone:160-299-5724
Mailing Address - Fax:
Practice Address - Street 1:31 WENARK DR APT 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1437
Practice Address - Country:US
Practice Address - Phone:160-299-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator