Provider Demographics
NPI:1861429003
Name:DAVIS, ALLEN B (MD)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:RM 339
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:736 CAMBRIDGE ST
Practice Address - Street 2:CARDINAL CUSHING PAVILION, 6TH FLOOR
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2907
Practice Address - Country:US
Practice Address - Phone:617-779-6800
Practice Address - Fax:617-779-6883
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2015-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA39337208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2041022Medicaid
MAJ03188Medicare ID - Type Unspecified
MAB74397Medicare UPIN