Provider Demographics
NPI:1912981507
Name:DAVIS, IRA C (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:C
Last Name:DAVIS
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 1:280 N CENTRAL AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1832
Mailing Address - Country:US
Mailing Address - Phone:914-288-0500
Mailing Address - Fax:914-288-0260
Practice Address - Street 1:280 N CENTRAL AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1832
Practice Address - Country:US
Practice Address - Phone:914-288-0500
Practice Address - Fax:914-288-0260
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY82F473Medicare ID - Type Unspecified
NYE86323Medicare UPIN