Organization
KENNETH H. DAVIDSON, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DAVIDSON MD (PRESIDENT)
(585) 426-9278
Entity
Organization
Contact information
Practice address
1415 PORTLAND AVE, SUITE 350, ROCHESTER, NY 14621-3038
(585) 426-9278
(585) 338-2738
Mailing address
1415 PORTLAND AVE, SUITE 350, ROCHESTER, NY 14621-3038
(585) 426-9278
(585) 338-2738
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
103663
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00450853
—
NY
01
—
005002871
BLUE SHIELD WESTERN NY
—
01
—
07341
CHOICE CARE
—
01
—
10453
GHI
—
01
—
4273339
AETNA
—
01
—
9913
BLUE CROSS BLUE SHIELD
—
01
—
MD4426
PREFERRED CARE
—
01
—
PO10103663
BLUE CHOICE - EXCELLUS
—
01
—
Y019296
CHAMPUS
—
Enumeration date
09/17/2007
Last updated
10/09/2013
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