Provider Demographics
NPI:1124056411
Name:CHICK, DAVOREN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVOREN
Middle Name:ANN
Last Name:CHICK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3701 MARKET ST
Mailing Address - Street 2:STE 640
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5545
Mailing Address - Country:US
Mailing Address - Phone:215-662-2250
Mailing Address - Fax:215-615-3995
Practice Address - Street 1:3701 MARKET ST
Practice Address - Street 2:STE 640
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5545
Practice Address - Country:US
Practice Address - Phone:215-662-2250
Practice Address - Fax:215-615-3995
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-08-29
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Provider Licenses
StateLicense IDTaxonomies
PAMD463225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4339117Medicaid
MIG03927Medicare UPIN
MI4339117Medicaid