Provider Demographics
NPI:1407824477
Name:DAVIS, MECHERY (MD)
Entity type:Individual
Prefix:
First Name:MECHERY
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 1:300 TOLL GATE RD
Mailing Address - Street 2:SUITE # LL6
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4416
Mailing Address - Country:US
Mailing Address - Phone:401-732-8700
Mailing Address - Fax:401-732-0079
Practice Address - Street 1:300 TOLL GATE RD
Practice Address - Street 2:SUITE # LL6
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4416
Practice Address - Country:US
Practice Address - Phone:401-732-8700
Practice Address - Fax:401-732-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10003207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149156OtherAETNA
RI405138OtherBLUECHIP
RI0402703OtherUNITED HEALTH CARE
RI9020927Medicaid
RI20927-8OtherBLUE CROSS&BLUE SHIELD
RI9020927Medicaid