MEDICARE: RENEE DANIELLE DAVIS

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	208600000X	Surgery Physician	MA057807	PA

General Provider Information

NPI Number	:	1093191439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE DANIELLE DAVIS

Provider Business Mailing Address
First Line	:	100 EXCELA HEALTH DR STE 202A
Second Line	:
City	:	LATROBE
State	:	PA
Zip	:	15650-9001
Country	:	US
Telephone Number	:	724-537-7100
Fax Number	:	724-537-9847

Provider Business Practice Location Address
First Line	:	100 EXCELA HEALTH DR STE 202A
Second Line	:
City	:	LATROBE
State	:	PA
Zip	:	15650-9001
Country	:	US
Telephone Number	:	724-537-7100
Fax Number	:	724-537-9847

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

Provider Enumeration Date	:	08/07/2015
Last Update Date	:	02/02/2026

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Directions to “ RENEE DANIELLE DAVIS ” Practice Location

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