Basic Information
| Provider Information | |||||||||
| NPI: | 1235198979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220423307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037764001 | ||||||||
| FaxNumber: | 7037767113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101048048 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1053714 | 01 | UNHC | OTHER | 540894297 | 01 | GW ONE HEALTH | OTHER | 6211917 | 05 | VA | MEDICAID | 502419 | 01 | NCPPO | OTHER | 540894297 | 01 | PHCS | OTHER | 0477529 | 01 | AETNA HMO | OTHER | 802912966 | 01 | DEA | OTHER | 317321 | 01 | ALLIANCE | OTHER | 34300006 | 01 | BCBS OF DC | OTHER | 440159 | 01 | ANTHEM | OTHER | 540894297 | 01 | MAILHANDLERS | OTHER | 206638 | 01 | MDIPA OPTIMUM | OTHER | 4303326 | 01 | AETNA | OTHER | 0101048048 | 01 | VA LICENSE | OTHER | 6213088002 | 01 | CIGNA | OTHER |