Provider Demographics
NPI:1760445506
Name:BURKETT, DONNA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNN
Last Name:BURKETT
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 1:2964 HYDRAULIC RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8902
Mailing Address - Country:US
Mailing Address - Phone:434-296-1000
Mailing Address - Fax:802-660-9438
Practice Address - Street 1:2964 HYDRAULIC RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8902
Practice Address - Country:US
Practice Address - Phone:434-296-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241288207Q00000X
NH16261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760445506Medicaid
NC89128P1Medicaid