Russell O Davis III, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

HOO69049 Issued in MD

Practice address

2480 Llewellyn Ave
Fort Meade, MD 20755-7081

Phone

(301) 677-8969

NPI assigned

Oct 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714089600000",
    "number": "1154416618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 FAIRRIDGE DR",
            "city": "CROWNSVILLE",
            "state": "MD",
            "postal_code": "210322324",
            "telephone_number": "301-677-8092",
            "fax_number": "301-677-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207557081",
            "telephone_number": "301-677-8969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "RUSSELL",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "HOO69049",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "DC",
            "license": "MD31454",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayleen M Crick, C.R.N.P.
• Francis Edward Criss Jr., PA-C
• Dennis J. Curtis, O.D.
• Bobbie Gene Davis, RN
• Martha Davis
• Tamatha Henderson Davis, LPN
• Sarah Deal, PSYD
• Kathleen Theresa Deck, PT
• Nancy Annette Demetrician, RN
• Susan A Demuth, M.D.

• Internal Medicine Physician in Fort Meade, MD
• Providers in Fort Meade, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.