Healthcare Provider Details

I. General information

NPI: 1427987122
Provider Name (Legal Business Name): MADISON DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 DOVE AVE
SALEM MA
01970-2944
US

IV. Provider business mailing address

10 WHIPPLE RD
SOUTH HAMILTON MA
01982-1518
US

V. Phone/Fax

Practice location:
  • Phone: 310-766-2572
  • Fax:
Mailing address:
  • Phone: 310-766-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberRN10030419
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: