Provider Demographics
NPI:1396742649
Name:IDDINGS, DONNA C (PA-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:C
Last Name:IDDINGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:300 HANOVER STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-679-7774
Practice Address - Fax:508-679-7724
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00207363AS0400X
MAPA739363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI410229OtherRI BL;UE CHIP
PR0000030813OtherRI BC/BS
RIRI00039Medicaid
RI410229OtherRI BL;UE CHIP