Healthcare Provider Details

I. General information

NPI: 1215956529
Provider Name (Legal Business Name): RANDY FRANK DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BOSTON ST STE J2
BALTIMORE MD
21224-5251
US

IV. Provider business mailing address

450 GARRISONVILLE RD STE 109
STAFFORD VA
22554-1615
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-2727
  • Fax: 703-542-3753
Mailing address:
  • Phone: 703-522-2727
  • Fax: 703-542-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberD0024332
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: