Provider Demographics
NPI:1306864061
Name:WATERS, DONNA (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:WATERS
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 1:3600 PRYTANIA ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3628
Mailing Address - Country:US
Mailing Address - Phone:504-897-7197
Mailing Address - Fax:
Practice Address - Street 1:3434 PRYTANIA ST
Practice Address - Street 2:SUITE 320
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3532
Practice Address - Country:US
Practice Address - Phone:504-897-7142
Practice Address - Fax:504-210-4286
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD018433207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1920860Medicaid
E25182Medicare UPIN
LA5K884D516Medicare PIN