Provider Demographics
NPI:1649334798
Name:THORNTON DAVIS, TRASHAWN NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:TRASHAWN
Middle Name:NICOLE
Last Name:THORNTON DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST KAISER PERMANENTE
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:5100 AUTH WAY
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4201
Practice Address - Country:US
Practice Address - Phone:301-702-5148
Practice Address - Fax:301-702-5118
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035356207V00000X
MDD63098207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I41343Medicare UPIN
017953K92Medicare ID - Type Unspecified