Provider Demographics
NPI:1083676597
Name:LOSCO-STORY, DONNA M (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:LOSCO-STORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:LOSCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:941-202-5342
Practice Address - Street 1:250 2ND ST E STE 4G
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1028
Practice Address - Country:US
Practice Address - Phone:941-243-3983
Practice Address - Fax:941-896-3795
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01598810Medicaid
NY0105CIMedicare ID - Type Unspecified
G10521Medicare UPIN