Provider Demographics
NPI:1659430692
Name:TWISDALE, DONNA R (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:TWISDALE
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 1:4 ETHEL ROAD
Mailing Address - Street 2:SUITE 402B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:732-287-3643
Mailing Address - Fax:732-287-3406
Practice Address - Street 1:4 ETHEL ROAD
Practice Address - Street 2:SUITE 402B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-287-3643
Practice Address - Fax:732-287-3406
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03696500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LP115OtherOXFORD
LP115OtherOXFORD
454542SFSMedicare ID - Type Unspecified