Healthcare Provider Details

I. General information

NPI: 1609949254
Provider Name (Legal Business Name): MIRYAM M DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW #206
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

7012 RIVER RD
BETHESDA MD
20817-4752
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-7300
  • Fax: 202-726-6031
Mailing address:
  • Phone: 301-229-6250
  • Fax: 301-320-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMD4085
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD4085
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: