Provider Demographics
NPI:1629228473
Name:LANDEN, DONNA A (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:LANDEN
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4916 PLANK RD
Practice Address - Street 2:
Practice Address - City:NORTH GARDEN
Practice Address - State:VA
Practice Address - Zip Code:22959-1613
Practice Address - Country:US
Practice Address - Phone:434-243-4660
Practice Address - Fax:434-977-3703
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258853207Q00000X
TXFTL 42395207Q00000X
TXN2157207Q00000X
AL29583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL120764Medicaid
TX8AN555OtherBCBS
ALP00834407OtherRAILROAD MEDICARE
TX8AN555OtherBCBS
ALP00834407OtherRAILROAD MEDICARE
AL120764Medicaid
AL03922765Medicaid
TX8L3307Medicare PIN