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General NPI Number Information
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NPI Number | 1821393620
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Entity Type | Individual
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Provider Name | CAROL DENISE DAVIS D.O., MSPH
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 30 BELL AVENUE BLDGE 490 OMC BROOKHAVEN NATIONAL LABORATORY
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City | UPTON
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State | NY
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Zip | 11973
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Country | US
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Telephone | 631-344-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BELL AVENUE BLDGE 490 OMC BNL
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City | UPTON
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State | NY
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Zip | 11973
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Country | US
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Telephone | 631-344-3760
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Fax |
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 193982
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License Number State | NY
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