MEDICARE: MR. MARK ALBERT DAVIS RD.LDN

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	133V00000X	Registered Dietitian	DN000962	PA

General Provider Information

NPI Number	:	1306462650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ALBERT DAVIS RD.LDN

Provider Business Mailing Address
First Line	:	810 CLAIRTON BLVD STE 400
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-5511
Country	:	US
Telephone Number	:	412-650-1179
Fax Number	:	412-650-1171

Provider Business Practice Location Address
First Line	:	810 CLAIRTON BLVD STE 400
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-5511
Country	:	US
Telephone Number	:	412-650-1170
Fax Number	:	412-650-1171

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	10/09/2020

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