Jerome Gary Davidson, MD

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

A22489 Issued in CA

Practice address

18300 Roscoe Blvd
Northridge, CA 91325-4105

Phone

(818) 700-2336

Fax

(818) 700-2337

NPI assigned

Jul 19, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Valley Hematology Oncology Medical Group

  • Hematology & Oncology Physician
  • Northridge, CA
  • NPI 1902108293

  Hematology & Oncology

  NPD (past) Authorized official
• Intensive Care Medical Group Inc

  • Pulmonary Disease Physician
  • Northridge, CA
  • NPI 1902178122
  NPD (past)
• North Valley Hematology/Oncology Medical Group

  • Hematology & Oncology Physician
  • Mission Hills, CA
  • NPI 1134420201

  Hematology & Oncology

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307491200000",
    "number": "1114926490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11307",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924231307",
            "telephone_number": "818-700-2336",
            "fax_number": "818-700-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18300 ROSCOE BLVD",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254105",
            "telephone_number": "818-700-2336",
            "fax_number": "818-700-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "JEROME",
        "middle_name": "GARY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2011-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A22489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOA224890",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114926490",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902108293",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alan Darush, M.D.
• David J Rudolph DDS Inc.
• David M Shultz M D , Inc
• David P Lunt, DDS, Inc
• Lalita Davidoff, PMHNP
• Sheldon Jerome Davidson, MD
• Pamela Marie Davis, MD
• James Burton Dawson
• Day & Night Assisted Living LLC
• Daylight Psychiatry and Wellness a Professional Nursing Corporation

• All providers in Northridge, CA
• Hematology & Oncology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.