Provider Demographics
NPI:1841251337
Name:CHRISANDERSON, DONNA ANDREA (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ANDREA
Last Name:CHRISANDERSON
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 1:2040 MILLBURN AVENUE #402
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040
Mailing Address - Country:US
Mailing Address - Phone:973-378-9070
Mailing Address - Fax:973-378-8797
Practice Address - Street 1:2040 MILLBURN AVENUE #402
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040
Practice Address - Country:US
Practice Address - Phone:973-378-9070
Practice Address - Fax:973-378-9070
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ59324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5523907Medicaid
747508Medicare ID - Type Unspecified
NJ5523907Medicaid