Active NPI
Robert A Davis Jr., MD
- Surgery Physician
- Edenton, NC
National Provider Identifier
1578564332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 30145
- Practice address
- 203-B Earnhardt Dr.
Ecu Physicians Surgery Chowan Hospital
Edenton, NC 27932 - Phone
- (252) 482-5868
- Fax
- (252) 482-7953
- NPI assigned
- Aug 2, 2005
- Last updated
- Nov 23, 2011
- Sex
- Male
- Sole proprietor
- No
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 | 30145 | NC | Primary |
Addresses
Primary practice location
203-B Earnhardt Dr.
Ecu Physicians Surgery Chowan Hospital
Edenton, NC 27932
Mailing address
PO Box 751069
Ecu Physicians
Charlotte, NC 28275-1069
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8927914 | Medicaid | NC | |
| 27914 | Other | NC | BCBS NC |
| 020051953 | Other | NC | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| 30145 | NC | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chowan Professional Services, LLC | Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba University Health Systems - Edenton Surgical Practice
- Surgery Physician
- Edenton, NC
- NPI 1396979332
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1578564332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 751069",
"address_2": "ECU PHYSICIANS",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282751069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203-B EARNHARDT DR.",
"address_2": "ECU PHYSICIANS SURGERY CHOWAN HOSPITAL",
"city": "EDENTON",
"state": "NC",
"postal_code": "27932",
"telephone_number": "252-482-5868",
"fax_number": "252-482-7953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-02",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "30145",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8927914",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NC",
"identifier": "27914",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020051953",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edenton, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 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.