Provider Demographics
NPI:1215956529
Name:DAVIS, RANDY FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:FRANK
Last Name:DAVIS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 GARRISONVILLE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1615
Mailing Address - Country:US
Mailing Address - Phone:703-522-2727
Mailing Address - Fax:703-542-3753
Practice Address - Street 1:3500 BOSTON ST STE J2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5251
Practice Address - Country:US
Practice Address - Phone:703-522-2727
Practice Address - Fax:703-542-3753
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024332208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD451GMedicare ID - Type Unspecified
MDD70352Medicare UPIN