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General NPI Number Information
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NPI Number | 1538261698
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Entity Type | Individual
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Provider Name | DONNA WAY TILSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 811 NORTHGATE BLVD VA HEALTH CARE CENTER
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City | NEW ALBANY
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State | IN
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Zip | 47150-6419
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Country | US
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Telephone | 502-287-4100
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Fax | 812-941-0963
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Provider Business Mailing Address
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Address Line | 4026 ORMOND RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-2036
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Country | US
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Telephone | 502-897-6882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 24124
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License Number State | KY
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