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General NPI Number Information
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NPI Number | 1831885615
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Entity Type | Individual
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Provider Name | SAMUEL DAVIDSON
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Gender | Male
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 6 LEXINGTON ST STE 300
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City | WALTHAM
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State | MA
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Zip | 02452-4401
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Country | US
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Telephone | 978-662-1002
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Fax | 978-767-4757
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Provider Business Mailing Address
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Address Line | 6 LEXINGTON ST
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City | WALTHAM
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State | MA
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Zip | 02452-4401
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Country | US
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Telephone | 978-662-1002
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Fax | 978-767-4757
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2338730
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN2338730
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License Number State | MA
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