Healthcare Provider Details

I. General information

NPI: 1083176499
Provider Name (Legal Business Name): ANDREW JOHN OGILVIE DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT STREET 5TH FL PULMONARY
BALTIMORE MD
21264-3916
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2304
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD0098375
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: