Healthcare Provider Details

I. General information

NPI: 1225667975
Provider Name (Legal Business Name): KEITHARA DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911-1921 JEROME AVENUE 5TH FLOOR
BRONX NY
10453
US

IV. Provider business mailing address

30 EAST 33RD STREET 5TH FLOOR
NEW YORK NY
10016-5337
US

V. Phone/Fax

Practice location:
  • Phone: 718-943-1341
  • Fax: 718-716-3754
Mailing address:
  • Phone: 212-366-4459
  • Fax: 347-823-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number329216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: