Healthcare Provider Details

I. General information

NPI: 1891767018
Provider Name (Legal Business Name): BRIAN D DAVISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST SUITE 115
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

PO BOX 9137
BROOKLINE MA
02446-9137
US

V. Phone/Fax

Practice location:
  • Phone: 508-626-8346
  • Fax:
Mailing address:
  • Phone: 800-927-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number152302
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number152302
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: