Provider Demographics
NPI:1730114422
Name:TESTA, DONNA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIE
Last Name:TESTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:TESTA
Other - Last Name:LAWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 SPRUCE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1234
Mailing Address - Country:US
Mailing Address - Phone:570-373-2100
Mailing Address - Fax:570-373-2101
Practice Address - Street 1:1100 SPRUCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1234
Practice Address - Country:US
Practice Address - Phone:570-373-2100
Practice Address - Fax:570-373-2101
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019263E207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50045077OtherCAPITAL BLUE CROSS
PA0006637380005Medicaid
PATE147657OtherHIGHMARK BLUE SHIELD
PA147657FLTMedicare ID - Type Unspecified
PA0006637380005Medicaid