Basic Information
| Provider Information | |||||||||
| NPI: | 1023250685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | DZINTRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 MICHIGAN AVE NW | ||||||||
| Address2: | CHILDREN'S NATIONAL HEALTH SYSTEM | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024765000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 111 MICHIGAN AVE NW | ||||||||
| Address2: | CHILDREN'S NATIONAL HEALTH SYSTEM | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024765000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2009 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | D0077852 | MD | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 0101356295 | VA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 55211-020 | WI | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | MD042533 | DC | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.