Healthcare Provider Details

I. General information

NPI: 1851355614
Provider Name (Legal Business Name): WILLIAM DAVIDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 WILLOWBROOK RD
CUMBERLAND MD
21502-6491
US

IV. Provider business mailing address

305 HOSPITAL DR SUITE 305 TATE CENTER
GLEN BURNIE MD
21061-5805
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-8720
  • Fax:
Mailing address:
  • Phone: 410-768-3701
  • Fax: 410-766-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD14747
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number51208
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberD14747
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0014147
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: