Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 25MA05237400 | NJ |
Y | 2080P0202X | Pediatric Cardiologist | MD042598E | PA |
NPI | 1235127119 |
---|---|
Provider Name | Alexander Davidson |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 16/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001154997 | (05) | PA |
E12835 | (02) |