Basic Information
| Provider Information | |||||||||
| NPI: | 1134583727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVENPORT | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4470 REGENCY PL STE 106 | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206953085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402522140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4414 BENNING RD NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200194555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024694699 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2016 | ||||||||
| LastUpdateDate: | 08/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD047999 | DC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | D0092091 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | A141815 | 05 | CA | MEDICAID |