Provider Demographics
NPI:1457729048
Name:KLEMOVITCH, DONNAROSE (PA-C)
Entity type:Individual
Prefix:MS
First Name:DONNAROSE
Middle Name:
Last Name:KLEMOVITCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 GOLDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2026
Mailing Address - Country:US
Mailing Address - Phone:703-250-0510
Mailing Address - Fax:
Practice Address - Street 1:11226 GOLDFLOWER CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-2026
Practice Address - Country:US
Practice Address - Phone:703-250-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840347208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery