Healthcare Provider Details

I. General information

NPI: 1467713149
Provider Name (Legal Business Name): DAVID J DAVIN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E GENESEE ST SUITE 204
SYRACUSE NY
13210-1892
US

IV. Provider business mailing address

1000 E GENESEE ST SUITE 204
SYRACUSE NY
13210-1892
US

V. Phone/Fax

Practice location:
  • Phone: 315-475-5864
  • Fax: 315-475-6879
Mailing address:
  • Phone: 315-475-5864
  • Fax: 315-475-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number138897
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number138897
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID JOHN DAVIN
Title or Position: OWNER
Credential: M.D.
Phone: 315-475-5864