Provider Demographics
NPI:1831369719
Name:DAVISON, AMY JO (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:JO
Last Name:DAVISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:197 COUNTY ROUTE 10
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12526-5022
Mailing Address - Country:US
Mailing Address - Phone:518-567-9977
Mailing Address - Fax:518-851-3410
Practice Address - Street 1:197 COUNTY ROUTE 10
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:NY
Practice Address - Zip Code:12526-5022
Practice Address - Country:US
Practice Address - Phone:518-567-9977
Practice Address - Fax:518-851-3410
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY243611208000000X, 2081N0008X, 208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I42042Medicare UPIN