Provider Demographics
NPI:1629103114
Name:DONNA M CORVETTE MD PLLC
Entity Type:Organization
Organization Name:DONNA M CORVETTE MD PLLC
Other - Org Name:DERMTOLOGY CENTER OF WILLIAMSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-645-3787
Mailing Address - Street 1:5335 DISCOVERY PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188
Mailing Address - Country:US
Mailing Address - Phone:757-645-3787
Mailing Address - Fax:757-645-3774
Practice Address - Street 1:5335 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-645-3787
Practice Address - Fax:757-645-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3098297754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH06051Medicare UPIN
VAC09096Medicare ID - Type Unspecified