Provider Demographics
NPI:1700880606
Name:DARCY-LOESCHER, DONNAMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNAMARIE
Middle Name:
Last Name:DARCY-LOESCHER
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:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-375-3000
Mailing Address - Fax:
Practice Address - Street 1:4050 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203
Practice Address - Country:US
Practice Address - Phone:812-376-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036559A207R00000X
IN01036559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100342700Medicaid
IN000000991462OtherANTHEM PIN
IN250550AMedicare PIN
F33007Medicare UPIN
IN100342700Medicaid