1881620623 NPI number — JEFFREY P DONNELLY PA-C

Table of content: JEFFREY P DONNELLY PA-C (NPI 1881620623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881620623 NPI number — JEFFREY P DONNELLY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONNELLY
Provider First Name:
JEFFREY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881620623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24863
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTIANSTED
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00824-0863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-642-5460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
516 STRAND ST
Provider Second Line Business Practice Location Address:
FREDERIKSTED HEALTH CENTER
Provider Business Practice Location Address City Name:
FREDERIKSTED
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00840-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-772-0260
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  060 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)