Healthcare Provider Details

I. General information

NPI: 1184633133
Provider Name (Legal Business Name): MARTIN A DAVIDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DEGRANDPRE WAY
PLATTSBURGH NY
12901-6449
US

IV. Provider business mailing address

1479 HIGHLAND RD
KEESEVILLE NY
12944-2330
US

V. Phone/Fax

Practice location:
  • Phone: 518-834-9310
  • Fax: 518-834-1148
Mailing address:
  • Phone: 518-834-9310
  • Fax: 518-834-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number201408
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number201408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: