| Mark Davidson MD Inc | |
|
8631 W 3rd St # 1135e Los Angeles CA 90048-5901 | |
| (310) 855-0222 | |
| (310) 652-1905 |
| Full Name | Mark Davidson MD Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8631 W 3rd St # 1135e, Los Angeles, California |
| Authorized Official Name and Position | Mark Mehrdad Davidson (PRESIDENT) |
| Authorized Official Contact | 3108550222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Davidson MD Inc Po Box 7487 Beverly Hills CA 90212-7487 Ph: (310) 855-0222 | Mark Davidson MD Inc 8631 W 3rd St # 1135e Los Angeles CA 90048-5901 Ph: (310) 855-0222 |
| NPI Number | 1033142344 |
|---|---|
| Provider Enumeration Date | 07/09/2006 |
| Last Update Date | 05/03/2024 |
| Certification Date | 04/23/2024 |
| Medicare PECOS PAC ID | 1951554591 |
|---|---|
| Medicare Enrollment ID | O20130110000502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033142344 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | A67586 (California) | Primary |
| Provider Name | Mark M Davidson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1164459178 PECOS PAC ID: 0648261727 Enrollment ID: I20040518001588 |
| Provider Name | Cameron S Sikavi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1114303302 PECOS PAC ID: 6103161732 Enrollment ID: I20220601000668 |
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