Provider Demographics
NPI:1992757413
Name:DAVY, MARK FERRIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:FERRIS
Last Name:DAVY
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:PO BOX 28780
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-8780
Mailing Address - Country:US
Mailing Address - Phone:804-346-1515
Mailing Address - Fax:804-270-2888
Practice Address - Street 1:6900 FOREST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1729
Practice Address - Country:US
Practice Address - Phone:804-346-1515
Practice Address - Fax:804-270-2888
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA416318OtherSOUTHERN HEALTH
VA5603285Medicaid
VA552640OtherAETNA NON-HMO
VA669790OtherAETNA HMO
VA34359OtherOPTIMA
VA0100104OtherUNITED HEALTHCARE
VA10499OtherCIGNA
VA116027OtherANTHEM BCBS
VA34359OtherOPTIMA
VA080126500Medicare PIN
VA080006593Medicare PIN
VACB4715Medicare Oscar/Certification
VAC05724Medicare Oscar/Certification