Healthcare Provider Details

I. General information

NPI: 1770073264
Provider Name (Legal Business Name): HEATHER O. DAVIDSON, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BRISTOL RD
WELLESLEY MA
02481-2613
US

IV. Provider business mailing address

240 BRISTOL RD
WELLESLEY MA
02481-2613
US

V. Phone/Fax

Practice location:
  • Phone: 781-237-7700
  • Fax: 781-237-7703
Mailing address:
  • Phone: 781-237-7700
  • Fax: 781-237-7703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212992
License Number StateMA

VIII. Authorized Official

Name: DR. HEATHER OPPENHEIM DAVIDSON
Title or Position: CO-OWNER
Credential: MD
Phone: 781-237-7700