Provider Demographics
NPI:1518039981
Name:D ELIA, DONNA LOUISE (MD)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LOUISE
Last Name:D ELIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:L
Other - Last Name:CRUDELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2301 EVESHAM ROAD
Mailing Address - Street 2:BLD 800 STE 122
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-770-9300
Mailing Address - Fax:856-700-9518
Practice Address - Street 1:2301 EVESHAM ROAD
Practice Address - Street 2:BLD 800 STE 122
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-770-9300
Practice Address - Fax:856-700-9518
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56637207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ79436Medicare ID - Type Unspecified
F36912Medicare UPIN