Healthcare Provider Details

I. General information

NPI: 1467468835
Provider Name (Legal Business Name): M COLLEEN O'NEIL DAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 655
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 655
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-3015
  • Fax:
Mailing address:
  • Phone: 585-341-3015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number178983
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number178983
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: