Healthcare Provider Details

I. General information

NPI: 1174595334
Provider Name (Legal Business Name): ANDREW M DAVIDSON CLINICAL PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WOOD RD
ANNAPOLIS MD
21402-1257
US

IV. Provider business mailing address

250 WOOD RD
ANNAPOLIS MD
21402-1257
US

V. Phone/Fax

Practice location:
  • Phone: 410-293-4378
  • Fax:
Mailing address:
  • Phone: 410-293-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810000333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: