Healthcare Provider Details

I. General information

NPI: 1548362700
Provider Name (Legal Business Name): REBECCA DAVIDSON KALTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA SUZANNE DAVIDSON MD

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4724
  • Fax: 571-472-0241
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101257471
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101257471
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD420348
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: