Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD061890L | PA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD061890L | PA |
NPI | 1487618237 |
---|---|
Provider Name | Dr. Charles M Davis III |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 30/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016439810002 | (05) | PA |
F44762 | (02) |