Healthcare Provider Details

I. General information

NPI: 1467487421
Provider Name (Legal Business Name): CARRIE M DAVIES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIN STREET PEDIATRICS 77 WEST MAIN STREET
HOPKINTON MA
01748
US

IV. Provider business mailing address

MAIN STREET PEDIATRICS 77 WEST MAIN STREET
HOPKINTON MA
01748
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-5506
  • Fax:
Mailing address:
  • Phone: 508-435-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number156562
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: