Provider Demographics
NPI:1992993794
Name:DAVIS, ELLEN CHENEY (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHENEY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:CHENEY
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 FRANKLIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2104
Mailing Address - Country:US
Mailing Address - Phone:207-369-1106
Mailing Address - Fax:207-369-1180
Practice Address - Street 1:420 FRANKLIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2104
Practice Address - Country:US
Practice Address - Phone:207-369-1106
Practice Address - Fax:207-369-1180
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202518208600000X
MEMD19939208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003185001Medicare UPIN
ME003185002Medicare UPIN