MEDICARE: STEPHEN V. DAVIS, M.D.,P.C.

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	207RC0000X	Cardiovascular Disease Physician	01010382033	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174610	OTHER	VA	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1811186026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN V. DAVIS, M.D.,P.C.

Provider Business Mailing Address
First Line	:	200 DEER RUN RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-2866
Country	:	US
Telephone Number	:	434-799-0090
Fax Number	:	434-799-0098

Provider Business Practice Location Address
First Line	:	200 DEER RUN RD
Second Line	:
City	:	DANVILLE
State	:	VA
Zip	:	24540-2866
Country	:	US
Telephone Number	:	434-799-0090
Fax Number	:	434-799-0098

Authorized Official
Title or Position	:	OFC MGR/CORPORATE SECRETARY
Name	:	KATHY ANN RICE
Credential	:
Telephone Number	:	434-799-0090

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/26/2007

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