Healthcare Provider Details

I. General information

NPI: 1629170154
Provider Name (Legal Business Name): RESA ELIZABETH DAVIS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44365 PREMIER PLZ STE 220
ASHBURN VA
20147-5058
US

IV. Provider business mailing address

44365 PREMIER PLZ STE 220
ASHBURN VA
20147-5058
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-0121
  • Fax: 703-858-0710
Mailing address:
  • Phone: 703-858-0121
  • Fax: 703-858-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234951
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: