Provider Demographics
NPI:1154312759
Name:COLVIN, DONALD B (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:B
Last Name:COLVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 PROPERSITY AVENUE
Mailing Address - Street 2:200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-280-2841
Mailing Address - Fax:703-280-4773
Practice Address - Street 1:2710 PROPERSITY AVENUE
Practice Address - Street 2:200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-280-2841
Practice Address - Fax:703-280-4773
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010136746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7300034Medicaid
VA7300034Medicaid