Provider Demographics
NPI:1124065180
Name:DAVIS, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:1344 S DIVISION ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6921
Mailing Address - Country:US
Mailing Address - Phone:410-543-8880
Mailing Address - Fax:410-749-4426
Practice Address - Street 1:1344 S DIVISION ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6921
Practice Address - Country:US
Practice Address - Phone:410-543-8880
Practice Address - Fax:410-749-4426
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD77604Medicare UPIN