Provider Demographics
NPI:1003882275
Name:WININGHAM, DONNA E (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:E
Last Name:WININGHAM
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:DEPT LA 21613
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1613
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-409-7005
Practice Address - Street 1:2320 BATH STREET,
Practice Address - Street 2:SUITE 113
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5322
Practice Address - Country:US
Practice Address - Phone:805-682-7744
Practice Address - Fax:805-682-3321
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC403322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C403320OtherBC/BS OF CA
CA00C403320Medicaid
CA1003882275Medicaid
CA00C403320OtherBC/BS OF CA
E83314Medicare UPIN
WC40332Medicare PIN
CACX053YMedicare UPIN