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General NPI Number Information
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NPI Number | 1376679936
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Entity Type | Organization
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Legal Business Name | IRA DAVIS, MD, PLLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 280 N CENTRAL AVE SUITE 114
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City | HARTSDALE
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State | NY
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Zip | 10530-1832
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Country | US
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Telephone | 914-288-0500
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Fax | 914-288-0260
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Provider Business Mailing Address
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Address Line | 280 N CENTRAL AVE SUITE 114
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City | HARTSDALE
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State | NY
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Zip | 10530-1832
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Country | US
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Telephone | 914-288-0500
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Fax | 914-288-0260
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. IRA C DAVIS
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Credential | MD
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Telephone | 914-288-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 182268
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 182268
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License Number State | NY
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