Provider Demographics
NPI:1568429256
Name:SASSAMAN, DONNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:SASSAMAN
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:PO BOX 29434
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:928-214-2922
Mailing Address - Fax:928-214-2932
Practice Address - Street 1:1200 N BEAVER ST
Practice Address - Street 2:FMC HOSPITALIST PROGRAM
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-214-2920
Practice Address - Fax:928-214-2925
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424100207R00000X, 208000000X
AZ44606207R00000X, 208000000X
ORMD165268208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305820Medicare PIN
I07700Medicare UPIN