Active NPI
Homer Bardo Davis Jr., M.D.
- Surgery Physician
- Chester, PA
National Provider Identifier
1487865689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD018636E
- Practice address
- 1 Medical Center Blvd
Chester, PA 19013-3902 - Phone
- (610) 447-2000
- NPI assigned
- May 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD018636E | PA | Primary |
Addresses
Primary practice location
1 Medical Center Blvd
Chester, PA 19013-3902
Mailing address
1117 King of Prussia Rd
Radnor, PA 19087-2831
Phone (610) 964-9005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD018636E | PA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487865689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1117 KING OF PRUSSIA RD",
"city": "RADNOR",
"state": "PA",
"postal_code": "190872831",
"telephone_number": "610-964-9005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 MEDICAL CENTER BLVD",
"city": "CHESTER",
"state": "PA",
"postal_code": "190133902",
"telephone_number": "610-447-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "HOMER",
"middle_name": "BARDO",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD018636E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chester, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.