Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD047999 | DC |
Y | 207VG0400X | Gynecologist | D0092091 | MD |
NPI | 1134583727 |
---|---|
Provider Name | Erica Renee Davenport |
First Address | White Plains, MD 20695-3085 |
Second Address | Washington, DC 20019-4555 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 29/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A141815 | (05) | CA |