Organization
CHARLES W DAVIS II MD LLC
Active
Organization
CHARLES W DAVIS II MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES W DAVIS II M.D. (SOLE MANAGER)
(410) 335-0008
Entity
Organization
Contact information
Practice address
331 OAK MANOR DR, SUITE 201, GLEN BURNIE, MD 21061-5548
(410) 625-5050
(410) 766-1404
Mailing address
PO BOX 62440, BALTIMORE, MD 21264-2440
(410) 625-5050
(410) 766-1404
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159276
MEDICARE PART B
MD
01
—
417933100
MEDICAL ASSISTANCE
MD
01
—
DCK7CW
CAREFIRST
MD
01
—
DP4271
RAILROAD MEDICARE GROUP PTAN
GA
01
—
Q647
CAREFIRST
DC
Enumeration date
07/15/2009
Last updated
11/04/2013
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