Basic Information
| Provider Information | |||||||||
| NPI: | 1750451381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARY M. DAVIDSON, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 WOODSTOWN HWY | ||||||||
| Address2: | |||||||||
| City: | HOLLSOPPLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159357119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144794034 | ||||||||
| FaxNumber: | 8144797166 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 WOODSTOWN HWY | ||||||||
| Address2: | |||||||||
| City: | HOLLSOPPLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159357119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144794034 | ||||||||
| FaxNumber: | 8144797166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAVIDSON | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8144794034 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD040789L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0011635930006 | 05 | PA | MEDICAID | 444015 | 01 | PA | HIGHMARK | OTHER |