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General NPI Number Information
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NPI Number | 1235389412
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Entity Type | Individual
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Provider Name | CORY BENNETT DAVIDSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 3822 COLONIAL AVE STE C
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City | ERIE
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State | PA
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Zip | 16506-3826
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Country | US
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Telephone | 814-616-0321
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Fax | 814-528-5643
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Provider Business Mailing Address
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Address Line | 3822 COLONIAL AVE STE C
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City | ERIE
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State | PA
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Zip | 16506-3826
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Country | US
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Telephone | 814-616-0321
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Fax | 814-528-5643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA053612
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License Number State | PA
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