Healthcare Provider Details

I. General information

NPI: 1568484780
Provider Name (Legal Business Name): CHRISTOPHER JOHN DAVIS M.D., M.P.H., M.B.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 ASHBOURNE RD
ROCHESTER NY
14618-1704
US

IV. Provider business mailing address

296 ASHBOURNE RD
ROCHESTER NY
14618-1704
US

V. Phone/Fax

Practice location:
  • Phone: 585-738-9535
  • Fax: 585-442-8494
Mailing address:
  • Phone: 585-738-9535
  • Fax: 585-442-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number145320
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number145320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: