Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD025517E | PA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD025517E | PA |
NPI | 1447208061 |
---|---|
Provider Name | Dwight Davis |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008256110001 | (05) | PA |
C32944 | (02) |