Healthcare Provider Details

I. General information

NPI: 1962447904
Provider Name (Legal Business Name): LONNIE D DAVIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR STE 180
ARLINGTON VA
22205-3633
US

IV. Provider business mailing address

8230 BOONE BLVD STE 200
TYSONS CORNER VA
22182-2647
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-1010
  • Fax:
Mailing address:
  • Phone: 703-848-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101239878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: