MEDICARE: DR. JENNI M. DAVIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MA07840100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053381129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNI M. DAVIS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 635
Second Line	:
City	:	BELLMAWR
State	:	NJ
Zip	:	08099-0635
Country	:	US
Telephone Number	:	856-770-5772
Fax Number	:	856-488-6546

Provider Business Practice Location Address
First Line	:	2201 CHAPEL AVE W
Second Line	:	KENNEDY MEMORIAL HOSPITAL-UMC
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-2048
Country	:	US
Telephone Number	:	856-488-6560
Fax Number	:	856-488-6546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	11/13/2008

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