Provider Demographics
NPI:1992886832
Name:DAVIS, TANYA RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:RENEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2616 SHERWOOD HALL LANE
Mailing Address - Street 2:#307
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306
Mailing Address - Country:US
Mailing Address - Phone:703-780-7010
Mailing Address - Fax:703-780-0017
Practice Address - Street 1:2616 SHERWOOD HALL LANE
Practice Address - Street 2:#307
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-780-7010
Practice Address - Fax:703-780-0017
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057044207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005846226Medicaid
VA005846226Medicaid
490642Medicare ID - Type Unspecified