Robert R Davidson, PA-C
Individual provider Active NPI Physician Assistant · Berlin, VT
NPI 1083623912 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083623912
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 550030361 (VT)
- Practice address
- 130 Fisher Rd
Berlin, VT 05602-9516 - Phone
- (802) 225-7000
- NPI assigned
- Aug 7, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 550030361 | VT | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 550030361 | VT | Yes |
Addresses
Primary practice location
130 Fisher Rd
Berlin, VT 05602-9516
Mailing address
14 N Pinnacle Ridge Rd
Waterbury, VT 05676-9140
Phone (802) 244-0850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OAP0864 | Medicaid | VT |
Other providers in Berlin, VT
- Richard Andrews Crandall III
- Mark E. Crane
- Denis Daigneault
- Peter Allen Dale
- Jedidiah P. Danforth
- Juliet Davis
- Rey L. Dean
- Ezra Demers
- Whitney Deming
- Elizabeth M. Diamond
All providers in Berlin, VT · Physician Assistant in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.