Provider Demographics
NPI:1104996693
Name:DAVIS, ADEN K (MD)
Entity type:Individual
Prefix:
First Name:ADEN
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 STONECREEK DR S STE 104
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9869
Mailing Address - Country:US
Mailing Address - Phone:614-636-5003
Mailing Address - Fax:
Practice Address - Street 1:1505 STONECREEK DR S STE 104
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9869
Practice Address - Country:US
Practice Address - Phone:614-636-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088819208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2695614Medicaid
OH2695614Medicaid
OHWI7361621Medicare PIN