Healthcare Provider Details

I. General information

NPI: 1235248956
Provider Name (Legal Business Name): ALEXIS DAVIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

17105 RUSSET DR
BOWIE MD
20716-3629
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8600
  • Fax: 301-295-8716
Mailing address:
  • Phone: 202-255-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003297
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: