Healthcare Provider Details

I. General information

NPI: 1619102050
Provider Name (Legal Business Name): RISA DANIELLE DAVIDSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RISA DANIELLE COHEN DO

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 04/17/2023
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12740 MEETING HOUSE RD
CARMEL IN
46032-7292
US

IV. Provider business mailing address

12740 MEETING HOUSE RD
CARMEL IN
46032-7292
US

V. Phone/Fax

Practice location:
  • Phone: 317-343-8844
  • Fax: 540-274-8548
Mailing address:
  • Phone: 317-343-8844
  • Fax: 540-274-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02003938A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: