Healthcare Provider Details

I. General information

NPI: 1326676842
Provider Name (Legal Business Name): MICHAEL DAVIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DEFENSE HWY STE 300
ANNAPOLIS MD
21401-8926
US

IV. Provider business mailing address

166 DEFENSE HWY STE 300
ANNAPOLIS MD
21401-8926
US

V. Phone/Fax

Practice location:
  • Phone: 443-808-1808
  • Fax:
Mailing address:
  • Phone: 443-808-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberH0104998
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH0104998
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberH0104998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: