Provider Demographics
NPI:1396719639
Name:DONNELLY, ANNE ROGERS (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ROGERS
Last Name:DONNELLY
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 1:1260 E WOODLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3969
Mailing Address - Country:US
Mailing Address - Phone:610-690-4490
Mailing Address - Fax:610-328-9391
Practice Address - Street 1:1260 E WOODLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3969
Practice Address - Country:US
Practice Address - Phone:610-690-4490
Practice Address - Fax:610-328-9391
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047005207Q00000X
PAMD454732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-002 / -003OtherTRICARE/CHAMPUS
VIPAROtherAETNA
VA005606257Medicaid
VAPAROtherVA PREMIER HEALTH
VAPAROtherVA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
NC5906354Medicaid
VAPAROtherMULTIPLAN
VAPAROtherCORVEL/CORCARE
VA005612209Medicaid
NC06354OtherBC/BS
VA21016OtherSENTARA/OPTIMA
VA434845OtherANTHEM
VA2180465OtherUHC/MAMSI
WAPAROtherCIGNA
VAPAROtherFIRST HEALTH COMMERCIAL
VAPAROtherVA PREMIER HEALTH
NC5906354Medicaid