MEDICARE: NEENA ALYSSA DAVISSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician	MD481171	PA
2	2085R0204X	Vascular & Interventional Radiology Physician	321768	NY

General Provider Information

NPI Number	:	1073045480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEENA ALYSSA DAVISSON M.D.

Provider Business Mailing Address
First Line	:	548 MACLEOD DR
Second Line	:
City	:	GIBSONIA
State	:	PA
Zip	:	15044-8962
Country	:	US
Telephone Number	:	724-612-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:	724-612-3434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	02/05/2026

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