Provider Demographics
NPI:1194903435
Name:CHRISTOPHER J. DAVIDSON, M.D., LLC
Entity type:Organization
Organization Name:CHRISTOPHER J. DAVIDSON, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GRANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-667-5230
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6219
Mailing Address - Country:US
Mailing Address - Phone:978-667-5230
Mailing Address - Fax:
Practice Address - Street 1:332 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-6219
Practice Address - Country:US
Practice Address - Phone:978-667-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223532208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2117827Medicaid
MAI56570Medicare UPIN
MA0005644Medicare PIN