Provider Demographics
NPI:1720325772
Name:DAVIS HEALTH PC
Entity type:Organization
Organization Name:DAVIS HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FABRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-640-1402
Mailing Address - Street 1:1 CLINTON PATH
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4207
Mailing Address - Country:US
Mailing Address - Phone:617-640-1402
Mailing Address - Fax:
Practice Address - Street 1:275 HANCOCK ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2249
Practice Address - Country:US
Practice Address - Phone:617-640-1402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service