Healthcare Provider Details

I. General information

NPI: 1831490051
Provider Name (Legal Business Name): ROBERT GEORGE DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 ASHTON AVE STE 212
MANASSAS VA
20109-5701
US

IV. Provider business mailing address

8140 ASHTON AVE SUITE 212
MANASSAS VA
20109-5701
US

V. Phone/Fax

Practice location:
  • Phone: 703-365-9085
  • Fax: 703-365-0269
Mailing address:
  • Phone: 703-365-9085
  • Fax: 703-365-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101249187
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number259172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: