Healthcare Provider Details

I. General information

NPI: 1265796577
Provider Name (Legal Business Name): NOAH DAVIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 08/18/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

220 RIVERSIDE DR
SARANAC LAKE NY
12983-2377
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0437
  • Fax: 315-253-1702
Mailing address:
  • Phone: 206-920-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number018934
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003943
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: