Provider Demographics
NPI:1093343386
Name:ANSELMO, DONNA (DO)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ANSELMO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE COLONIAL PLACE
Mailing Address - Street 2:10571 TELEGRAPH ROAD #110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-266-9616
Mailing Address - Fax:
Practice Address - Street 1:ONE COLONIAL PLACE
Practice Address - Street 2:10571 TELEGRAPH ROAD #110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:804-266-1916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102208684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics