Provider Demographics
NPI:1053388686
Name:CHARIS-DONELSON, CHRISTINA M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:CHARIS-DONELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:C
Other - Last Name:DONELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-384-9668
Mailing Address - Fax:
Practice Address - Street 1:105 E 9TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2209
Practice Address - Country:US
Practice Address - Phone:319-467-2000
Practice Address - Fax:319-467-2410
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1453258Medicaid
IA38346OtherBCBS OF IOWA
IA38346OtherBCBS OF IOWA
BD8649937OtherFEDERAL DEA
IAI14685Medicare PIN