Provider Demographics
NPI:1790964831
Name:EDISON, DONNA LUCILE (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LUCILE
Last Name:EDISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WRAMC BLDG 2, ROOM 2J38
Mailing Address - Street 2:6900 GEORGIA AVE. NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0001
Mailing Address - Country:US
Mailing Address - Phone:202-782-6195
Mailing Address - Fax:
Practice Address - Street 1:WRAMC BLDG 6, DEPARTMENT OF PSYCHIATRY
Practice Address - Street 2:6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH421672084P0804X
CA20A5219 (INACTIVE)2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BE4940955OtherDEA