Provider Demographics
NPI:1316911456
Name:CORVETTE, DONNA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:CORVETTE
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 1:112 ANDREW LINDSEY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8934
Mailing Address - Country:US
Mailing Address - Phone:757-645-3787
Mailing Address - Fax:
Practice Address - Street 1:5335 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-645-3787
Practice Address - Fax:757-645-3774
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA309829 7754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADC2210Medicaid
VADC2210Medicaid
VAC-09096Medicare ID - Type UnspecifiedPIN#004655D96