1861491649 NPI number — MARIA W DAVISON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861491649 NPI number — MARIA W DAVISON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DAVISON

Provider First Name:

MARIA

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1861491649

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

05/05/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

717 STATE ST

Provider Second Line Business Mailing Address:

SUITE 16, LL

Provider Business Mailing Address City Name:

ERIE

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

16501-1341

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

814-480-7100

Provider Business Mailing Address Fax Number:

814-480-7604

Provider First Line Business Practice Location Address:

201 STATE ST

Provider Second Line Business Practice Location Address:

HAMOT EMERGENCY ROOM

Provider Business Practice Location Address City Name:

ERIE

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

16550-0002

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

814-877-6139

Provider Business Practice Location Address Fax Number:

814-877-6093

Provider Enumeration Date:

07/14/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207P00000X , with the licence number:  MD071114L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 00025502201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0018065770001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 1514335 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 02088062 . This is a "NY MEDICAL ASSISTANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 707942 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1068743 . This is a "WEST VIRGINIA WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 212518 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 930094341 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2217630 . This is a "OH MEDICAL ASSISTANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 2546394 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 107874 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".