Provider Demographics
NPI:1063401446
Name:GAMACHE, DONNA J (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:125 OLDE GREENWICH DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4001
Mailing Address - Country:US
Mailing Address - Phone:540-898-8001
Mailing Address - Fax:540-898-2127
Practice Address - Street 1:125 OLDE GREENWICH DR
Practice Address - Street 2:SUITE 220
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4001
Practice Address - Country:US
Practice Address - Phone:540-898-8001
Practice Address - Fax:540-898-2127
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2010-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101840583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00213352OtherRAILROAD MEDICARE
VA010139201Medicaid
VAP00213352OtherRAILROAD MEDICARE
G82441Medicare UPIN