MEDICARE: K.C. DAVIDES, MD, PC

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	208800000X	Urology Physician	MD032621L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG9607	OTHER	PA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1528241551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K.C. DAVIDES, MD, PC

Provider Business Mailing Address
First Line	:	1402 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1606
Country	:	US
Telephone Number	:	412-673-8429
Fax Number	:	412-673-8430

Provider Business Practice Location Address
First Line	:	1402 LINCOLN WAY
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-1606
Country	:	US
Telephone Number	:	412-673-8429
Fax Number	:	412-673-8430

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KYRIAKOS CONSTANTIN DAVIDES
Credential	:	M.D.
Telephone Number	:	412-673-8429

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	03/06/2008

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