Basic Information
| Provider Information | |||||||||
| NPI: | 1366429474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601372 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044461340 | ||||||||
| FaxNumber: | 7044461289 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172631220 | ||||||||
| FaxNumber: | 7172636255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 12/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 9900468 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD020597E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000805575 | 05 | PA | MEDICAID | 891364K | 05 | NC | MEDICAID | N0046C | 05 | SC | MEDICAID |