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) 625-5050
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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245901900
MEDICAL ASSISTANCE DME
MD
01
—
6525460001
MEDICARE DME
MD
Enumeration date
06/04/2013
Last updated
11/04/2013
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