MEDICARE: ERIC N DAVIDSON MD

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	207R00000X	Internal Medicine Physician	0101030796	VA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	012791	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1457390742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC N DAVIDSON MD

Provider Business Mailing Address
First Line	:	125 EXECUTIVE DR
Second Line	:	SUITE H
City	:	DANVILLE
State	:	VA
Zip	:	24541-4155
Country	:	US
Telephone Number	:	434-791-1345
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 EXECUTIVE DR
Second Line	:	SUITE H
City	:	DANVILLE
State	:	VA
Zip	:	24541-4155
Country	:	US
Telephone Number	:	434-791-1345
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/10/2010

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