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NPI Code Detail

MEDICARE: MELISSA S DAVIS M.D.

MEDICARE: MELISSA S DAVIS M.D.
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
1207Q00000XFamily Medicine Physician30210KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000578808OTHERBLUE CROSS AND BLUE SHIELD
2000000374866OTHERBLUE CROSS AND BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972574978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA S DAVIS M.D.
Provider Business Mailing Address
First Line : 1157 TABORLAKE WALK
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-7719
Country : US
Telephone Number : 606-571-3419
Fax Number :
Provider Business Practice Location Address
First Line : 2250 LEESTOWN RD
Second Line :
City : LEXINGTON
State : KY
Zip : 40511-1052
Country : US
Telephone Number : 859-233-4511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2006
Last Update Date : 02/24/2022

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