Provider Demographics
NPI:1336143130
Name:FONTANA, DONNA RAE (MD, PH D)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:RAE
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MD, PH D
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:RAE
Other - Last Name:BERNARDONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S STE 5100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:952-893-1959
Mailing Address - Fax:952-893-1954
Practice Address - Street 1:7600 FRANCE AVE S STE 5100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-893-1959
Practice Address - Fax:952-893-1954
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43392207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN960081034766OtherPREFERRED ONE
MN1889892OtherAMERICA'S PPO
MN776134100Medicaid
MNP00028980OtherRR MEDICARE
MN3200112OtherMEDICA
MN143431C477OtherUCARE
FM513G0FOOtherBLUE CROSS BLUE SHIELD
MN411774839A002OtherCHAMPUS
MNHP39095OtherHEALTHPARTNERS