Provider Demographics
NPI:1164266219
Name:DAVIS, ERIN MAE (DO)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MAE
Other - Last Name:LALIBERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1715
Mailing Address - Country:US
Mailing Address - Phone:703-391-2020
Mailing Address - Fax:703-264-9861
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1715
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:703-264-9861
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116039330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine