Healthcare Provider Details

I. General information

NPI: 1437491271
Provider Name (Legal Business Name): AMY L DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE DEPARTMENT OF PEDIATRICS
BALTIMORE MD
21229
US

IV. Provider business mailing address

2231 GOUGH ST
BALTIMORE MD
21231-2637
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-2011
  • Fax:
Mailing address:
  • Phone: 617-312-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD81998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: