MEDICARE: DR. DEANNA S DAVIDSON 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	2085R0001X	Radiation Oncology Physician	62935	MN
2	2085R0001X	Radiation Oncology Physician	015342	TN
3	2085R0001X	Radiation Oncology Physician	4301111121	MI
4	2085R0001X	Radiation Oncology Physician	35125742	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PAR	OTHER	VA	TRICARE CHAMPUS
2	PAR	OTHER	VA	USA MANAGED CARE
3	PAR	OTHER	VA	FIRST HEALTH COMMERCIAL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2177941	OTHER	VA	UHC/MAMSI
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	PAR	OTHER	VA	CORVEL/CORCARE
8	PAR	OTHER	VA	VIRGINIA HEALTH NETWORK
9	PAR	OTHER	VA	VA PREMIER HEALTH
10	PAR	OTHER	VA	MULTIPLAN
11	08761	OTHER	NC	NC BC/BS
12	1457317075	OTHER	VA	SENTARA/OPTIMA
13	343699	OTHER	VA	ANTHEM
14	5748084	OTHER	VA	AETNA
15	7333375	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1457317075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANNA S DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15035
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-0035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 W MARKET ST STE 100
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45805-2796
Country	:	US
Telephone Number	:	419-996-5063
Fax Number	:	419-996-5502

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

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	10/22/2024

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