Provider Demographics
NPI:1285743880
Name:DAVIS, WAYNE P (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2024 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3027
Mailing Address - Country:US
Mailing Address - Phone:202-595-3223
Mailing Address - Fax:202-332-2985
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-6797
Practice Address - Fax:202-865-4669
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD15507207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5884187Medicaid
DC010609600Medicaid
MD547571600Medicaid
MD547571600Medicaid
VA5884187Medicaid