Healthcare Provider Details

I. General information

NPI: 1386633501
Provider Name (Legal Business Name): CARY A DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 BETHLEHEM PIKE
MONTGOMERYVILLE PA
18936-9602
US

IV. Provider business mailing address

PO BOX 758952
BALTIMORE MD
21275-8952
US

V. Phone/Fax

Practice location:
  • Phone: 267-695-3944
  • Fax: 267-695-3945
Mailing address:
  • Phone: 804-968-5700
  • Fax: 804-217-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD033253E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: