Healthcare Provider Details

I. General information

NPI: 1396776563
Provider Name (Legal Business Name): ROBERT A DAVIS, MD FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N MAIN ST # 200
DUBLIN PA
18917-2107
US

IV. Provider business mailing address

PO BOX 77
DUBLIN PA
18917-0077
US

V. Phone/Fax

Practice location:
  • Phone: 215-249-9020
  • Fax: 215-249-3469
Mailing address:
  • Phone: 152-429-0202
  • Fax: 215-249-3469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039330L
License Number StatePA

VIII. Authorized Official

Name: PATRICIA HOFFMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 267-736-4850