Provider Demographics
NPI:1922560614
Name:EDWARDS, DONNA MARIE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 N CAPITOL AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1281
Mailing Address - Country:US
Mailing Address - Phone:317-962-8881
Mailing Address - Fax:
Practice Address - Street 1:1633 N CAPITOL AVE STE 640
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1281
Practice Address - Country:US
Practice Address - Phone:317-962-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program