MEDICARE: DR. KISHA N DAVIS 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	207Q00000X	Family Medicine Physician	D65224	MD

General Provider Information

NPI Number	:	1629110788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KISHA N DAVIS MD

Provider Business Mailing Address
First Line	:	5500 KNOLL NORTH DR
Second Line	:	SUITE 370
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2209
Country	:	US
Telephone Number	:	410-884-7831
Fax Number	:	410-715-3734

Provider Business Practice Location Address
First Line	:	5500 KNOLL NORTH DR
Second Line	:	SUITE 370
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2209
Country	:	US
Telephone Number	:	410-884-7831
Fax Number	:	410-715-3734

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/23/2007

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