Healthcare Provider Details

I. General information

NPI: 1801821491
Provider Name (Legal Business Name): ROBERT A DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/05/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 215-249-9020
  • Fax: 215-249-3469
Mailing address:
  • Phone: 215-249-9020
  • 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:
Title or Position:
Credential:
Phone: