Provider Demographics
NPI:1881640738
Name:GAVARONE, DONNA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:GAVARONE
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 1:9622 BUSTLETON AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-3100
Mailing Address - Country:US
Mailing Address - Phone:215-673-7067
Mailing Address - Fax:215-673-4966
Practice Address - Street 1:9622 BUSTLETON AVENUE
Practice Address - Street 2:SUITE 6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3100
Practice Address - Country:US
Practice Address - Phone:215-673-7067
Practice Address - Fax:215-673-4966
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007885L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014927600002Medicaid
PA0014927600002Medicaid
PA473482Medicare ID - Type Unspecified