Provider Demographics
NPI:1659326767
Name:AUBREY, DONNA LAWSON (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LAWSON
Last Name:AUBREY
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 13705
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24036-3705
Mailing Address - Country:US
Mailing Address - Phone:540-776-8337
Mailing Address - Fax:540-776-6856
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-731-2114
Practice Address - Fax:540-731-2526
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012315712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7245025Medicaid
300001048Medicare ID - Type Unspecified
E46544Medicare UPIN