Provider Demographics
NPI:1053352641
Name:DAVIDSON, DIANA L (MD)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:DAVIDSON
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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-519-8362
Mailing Address - Fax:256-519-8327
Practice Address - Street 1:911 BIG COVE ROAD
Practice Address - Street 2:PICU
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3738
Practice Address - Country:US
Practice Address - Phone:256-265-7791
Practice Address - Fax:256-265-7767
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012169208000000X
AL121692080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009949800Medicaid
AL051098799OtherBC PROVIDER NUMBER
ALC76626Medicare UPIN
AL051098799OtherBC PROVIDER NUMBER