Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OS013419 | PA |
N | 111NI0900X | Internist | OS013419 | PA |
N | 207RA0401X | Internist - Addiction Medicine | OS013419 | PA |
Y | 207RH0002X | Hospice and Palliative Medicine | OS013419 | PA |
NPI | 1063536902 |
---|---|
Provider Name | Amy Davis |
First Address | Bryn Mawr, PA 19010-0347 |
Second Address | Bryn Mawr, PA 19010-0347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2007 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1021954500001 | (05) | PA |
I40848 | (02) | PA |