Provider Demographics
NPI:1730181686
Name:DONNER, MARDA E (MD)
Entity type:Individual
Prefix:
First Name:MARDA
Middle Name:E
Last Name:DONNER
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 1:1148 KIBBEE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036-9620
Mailing Address - Country:US
Mailing Address - Phone:802-276-3808
Mailing Address - Fax:
Practice Address - Street 1:1148 KIBBEE RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:VT
Practice Address - Zip Code:05036-9620
Practice Address - Country:US
Practice Address - Phone:802-276-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011475207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009273170002Medicaid
PA438114Medicare ID - Type Unspecified
B41827Medicare UPIN