1629103114 NPI number — DONNA M CORVETTE MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629103114 NPI number — DONNA M CORVETTE MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONNA M CORVETTE MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629103114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5335 DISCOVERY PARK BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-645-3787
Provider Business Mailing Address Fax Number:
757-645-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5335 DISCOVERY PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-645-3787
Provider Business Practice Location Address Fax Number:
757-645-3774
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SELBY
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
757-645-3787

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  3098297754 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com