Provider Demographics
NPI:1629049002
Name:DAVIN, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:DAVIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-475-5864
Mailing Address - Fax:315-475-6879
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:SUITE 402
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-475-5864
Practice Address - Fax:315-475-6879
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-08-25
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Provider Licenses
StateLicense IDTaxonomies
NY1388971207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00782641Medicaid
NY00782641Medicaid
NYC59242Medicare UPIN