Healthcare Provider Details

I. General information

NPI: 1942209549
Provider Name (Legal Business Name): ROBERT SCOT DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/08/2024
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LYON PLACE
OGDENSBURG NY
13669
US

IV. Provider business mailing address

3 LYON PLACE
OGDENSBURG NY
13669
US

V. Phone/Fax

Practice location:
  • Phone: 315-713-5300
  • Fax: 866-506-5573
Mailing address:
  • Phone: 315-713-5300
  • Fax: 866-506-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number217141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: