MEDICARE: ANDREA 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	208000000X	Pediatrics Physician	MD467366	PA

General Provider Information

NPI Number	:	1205299625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DAVIS

Provider Business Mailing Address
First Line	:	11279 PERRY HWY STE 450
Second Line	:	SUITE 2
City	:	WEXFORD
State	:	PA
Zip	:	15090-9303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 NEW BUTLER RD
Second Line	:	SUITE 2
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-3231
Country	:	US
Telephone Number	:	246-542-7767
Fax Number	:

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

Provider Enumeration Date	:	04/02/2016
Last Update Date	:	03/25/2021

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Directions to “ ANDREA DAVIS ” Practice Location

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