Provider Demographics
NPI:1831227511
Name:DAVIES, ERIC J (PA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:DAVIES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 827408
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7408
Mailing Address - Country:US
Mailing Address - Phone:904-805-1300
Mailing Address - Fax:904-805-1302
Practice Address - Street 1:501 S UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3409
Practice Address - Country:US
Practice Address - Phone:443-843-5000
Practice Address - Fax:904-805-1302
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0002784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ07617Medicare UPIN
MDR298Medicare PIN
MD489PR298Medicare PIN
MD161MI794Medicare ID - Type Unspecified