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General NPI Number Information
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NPI Number | 1912100736
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Entity Type | Organization
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Legal Business Name | LORRAINE E. DAVIS MD
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 SIDNEY ROAD
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City | HOWES CAVE
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State | NY
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Zip | 12092
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Country | US
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Telephone | 518-868-2026
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Fax | 518-868-2027
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Provider Business Mailing Address
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Address Line | 109 SIDNEY ROAD
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City | HOWES CAVE
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State | NY
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Zip | 12092
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Country | US
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Telephone | 518-868-2026
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Fax | 518-868-2027
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORRAINE E DAVIS
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Credential | MD
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Telephone | 518-868-2026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 145901
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License Number State | NY
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