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NPI Code Detail

MEDICARE: GREGORY STEVEN DAVIDSON PA

MEDICARE: GREGORY STEVEN DAVIDSON PA
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
1363A00000XPhysician Assistant0110001809VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619934023
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY STEVEN DAVIDSON PA
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD
Second Line : SUITE A
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 895 MIDDLE GROUND BLVD
Second Line : SUITE 152
City : NEWPORT NEWS
State : VA
Zip : 23606-4250
Country : US
Telephone Number : 757-599-5505
Fax Number : 757-599-3618
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 10/04/2013

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Directions to “ GREGORY STEVEN DAVIDSON PA” Practice Location

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