=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689787905
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWIN A DAVISON JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 03/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 MAPLE AVE SUITE 3
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-5632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-584-5821
-----------------------------------------------------
Fax | 518-583-9404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 MAPLE AVE SUITE 3
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-5632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-584-5821
-----------------------------------------------------
Fax | 518-583-9404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 182490
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------