Provider Demographics
NPI:1538261698
Name:TILSON, DONNA WAY (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:WAY
Last Name:TILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:WAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4026 ORMOND RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2036
Mailing Address - Country:US
Mailing Address - Phone:502-897-6882
Mailing Address - Fax:
Practice Address - Street 1:811 NORTHGATE BLVD
Practice Address - Street 2:VA HEALTH CARE CENTER
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6419
Practice Address - Country:US
Practice Address - Phone:502-287-4100
Practice Address - Fax:812-941-0963
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine