Healthcare Provider Details

I. General information

NPI: 1396727665
Provider Name (Legal Business Name): MARK DAVIS-LORTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE PLAINS RD STE 201
TARRYTOWN NY
10591-5804
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-3053
  • Fax: 914-631-2807
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number195763
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberNYS195763
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: