MEDICARE: ANDREW DAVIDSON 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	207W00000X	Ophthalmology Physician	16343	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00171842	OTHER	NC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27222	OTHER	NC	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1073597050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW DAVIDSON M.D.

Provider Business Mailing Address
First Line	:	3515 TRENT RD
Second Line	:	SUITE 9
City	:	NEW BERN
State	:	NC
Zip	:	28562-2220
Country	:	US
Telephone Number	:	252-514-2155
Fax Number	:	252-514-0303

Provider Business Practice Location Address
First Line	:	3515 TRENT RD
Second Line	:	SUITE 9
City	:	NEW BERN
State	:	NC
Zip	:	28562-2220
Country	:	US
Telephone Number	:	252-514-2155
Fax Number	:	252-514-0303

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	07/08/2007

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