Basic Information
Provider Information
NPI: 1568808335
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVENPORT
FirstName: CLAIRE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 28082
Address2:  
City: NEW YORK
State: NY
PostalCode: 100878082
CountryCode: US
TelephoneNumber: 2129873100
FaxNumber: 2127315210
Practice Location
Address1: 1 GUSTAVE L. LEVY PLACE
Address2: MACE
City: NEW YORK
State: NY
PostalCode: 10029
CountryCode: US
TelephoneNumber: 2122416500
FaxNumber: 2128609737
Other Information
ProviderEnumerationDate: 05/20/2013
LastUpdateDate: 12/07/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0300X285353NYY Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
390200000X63312NYN Student, Health CareStudent in an Organized Health Care Education/Training Program 

ID Information
IDTypeStateIssuerDescription
0497161505NY MEDICAID


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