Healthcare Provider Details

I. General information

NPI: 1619203650
Provider Name (Legal Business Name): SUSAN FISCHER DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRICO COUNTY HEALTH DEPARTMENT 8600 DIXON POWERS DRIVE
HENRICO VA
23273-0775
US

IV. Provider business mailing address

HENRICO COUNTY HEALTH DEPARTMENT 8600 DIXON POWERS DRIVE, P.O. BOX 90775
HENRICO VA
23273-0775
US

V. Phone/Fax

Practice location:
  • Phone: 804-501-4522
  • Fax: 804-501-4983
Mailing address:
  • Phone: 804-501-4522
  • Fax: 804-501-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101058827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: