Provider Demographics
NPI:1780683052
Name:DAVIDIAN, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:DAVIDIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:140 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5509
Mailing Address - Country:US
Mailing Address - Phone:845-562-0138
Mailing Address - Fax:845-562-0147
Practice Address - Street 1:140 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5509
Practice Address - Country:US
Practice Address - Phone:845-562-0138
Practice Address - Fax:845-562-0147
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY186794207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46382OtherGHI HMO
NY69T112OtherEMPIRE BC
4624157OtherAETNA INSURANCE
NY0499062OtherGHI
NY1659392Medicaid
NY0499062OtherGHI
NY46382OtherGHI HMO
4624157OtherAETNA INSURANCE
NY1659392Medicaid
F88191Medicare UPIN