Healthcare Provider Details

I. General information

NPI: 1972597516
Provider Name (Legal Business Name): HARRY A DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PARK ST ELIZABETHTOWN COMMUNITY HOSPITAL
ELIZABETHTOWN NY
12932
US

IV. Provider business mailing address

PO BOX 277 ELIZABETHTOWN COMMUNITY HOSPITAL
ELIZABETHTOWN NY
12932
US

V. Phone/Fax

Practice location:
  • Phone: 518-873-6896
  • Fax: 518-873-6578
Mailing address:
  • Phone: 518-873-6377
  • Fax: 518-873-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberF8075
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1550291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: