MEDICARE: DR. KENNETH H 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	207RC0000X	Cardiovascular Disease Physician	103663	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	005002871	OTHER	BLUE SHIELD WESTERN NY
2	P010103663	OTHER	BLUE CHOICE
3	07341	OTHER	CHOICE CARE
4	10453	OTHER	GHI
5	9913	OTHER	BLUE CROSS BLUE SHIELD
6	Y019296	OTHER	CHAMPUS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MD4426	OTHER	PREFERRED CARE
9	005002871	OTHER	COMMUNITY BLUE

General Provider Information

NPI Number	:	1871565861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH H DAVIDSON MD

Provider Business Mailing Address
First Line	:	1415 PORTLAND AVE
Second Line	:	SUITE 350
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3038
Country	:	US
Telephone Number	:	585-426-9278
Fax Number	:	585-338-2738

Provider Business Practice Location Address
First Line	:	1415 PORTLAND AVE
Second Line	:	SUITE 350
City	:	ROCHESTER
State	:	NY
Zip	:	14621-3038
Country	:	US
Telephone Number	:	585-426-9278
Fax Number	:	585-338-2738

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	10/09/2013

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Directions to “ DR. KENNETH H DAVIDSON MD” Practice Location

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