Healthcare Provider Details

I. General information

NPI: 1023646098
Provider Name (Legal Business Name): SAMANTHA ELIZABETH DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 TRANSVERSE DR STE D
TOLEDO OH
43614-8008
US

IV. Provider business mailing address

3000 ARLINGTON AVE STOP 1108
TOLEDO OH
43614-2595
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-6900
  • Fax: 419-383-3269
Mailing address:
  • Phone: 419-383-5023
  • Fax: 419-383-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number35.153449
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.153449
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: