Provider Demographics
NPI:1891824041
Name:LAMARQUE-AMBROSE, DONNA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:LAMARQUE-AMBROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17452 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:CALLAO
Practice Address - State:VA
Practice Address - Zip Code:22435
Practice Address - Country:US
Practice Address - Phone:804-529-6141
Practice Address - Fax:804-529-6916
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891824041Medicaid
VAP00736117Medicare PIN
VA020055R53Medicare PIN