Healthcare Provider Details

I. General information

NPI: 1861638538
Provider Name (Legal Business Name): JOEL R DAVIDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 04/30/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE PERKINS SQ. LOCUST PEDIATRIC CARE GROUP, AKRON CHILDREN'S HOSPITAL
AKRON OH
44308-1062
US

IV. Provider business mailing address

ONE PERKINS SQUARE LOCUST PEDIATRIC CARE GROUP, LOCUST SUITE 390
AKRON OH
44308
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8530
  • Fax: 330-543-3731
Mailing address:
  • Phone: 330-543-8530
  • Fax: 330-543-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.014961
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.096888
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: