Healthcare Provider Details

I. General information

NPI: 1528078102
Provider Name (Legal Business Name): CRAYTONIA L. DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 E DEFENSE HIGHWAY
CROFTON MD
21114
US

IV. Provider business mailing address

PO BOX 6429
ANNAPOLIS MD
21401-0429
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-2273
  • Fax:
Mailing address:
  • Phone: 410-721-2273
  • Fax: 443-332-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0050025
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: