Provider Demographics
NPI:1366429474
Name:DAVIS, DANIEL THOMAS (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:THOMAS
Last Name:DAVIS
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 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-446-1340
Mailing Address - Fax:704-446-1289
Practice Address - Street 1:120 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1795
Practice Address - Country:US
Practice Address - Phone:717-263-1220
Practice Address - Fax:717-263-6255
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900468207X00000X
PAMD020597E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000805575Medicaid
NC891364KMedicaid
SCN0046CMedicaid
NC2025494DMedicare PIN
NC2025494CMedicare PIN
B96899Medicare UPIN
NC891364KMedicaid