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General NPI Number Information
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NPI Number | 1457547184
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Entity Type | Organization
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Legal Business Name | KENNETH H. DAVIDSON, MD, PC
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 1415 PORTLAND AVE SUITE 350
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City | ROCHESTER
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State | NY
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Zip | 14621-3038
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Country | US
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Telephone | 585-426-9278
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Fax | 585-338-2738
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Provider Business Mailing Address
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Address Line | 1415 PORTLAND AVE SUITE 350
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City | ROCHESTER
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State | NY
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Zip | 14621-3038
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Country | US
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Telephone | 585-426-9278
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Fax | 585-338-2738
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH DAVIDSON
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Credential | MD
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Telephone | 585-426-9278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 103663
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License Number State | NY
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