1548263981 NPI number — DR. JOSEPH R DONATELLE O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548263981 NPI number — DR. JOSEPH R DONATELLE O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DONATELLE

Provider First Name:

JOSEPH

Provider Middle Name:

R

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

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:

1548263981

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/29/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1268 SUMNER AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SPRINGFIELD

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01118-1770

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

413-782-5339

Provider Business Mailing Address Fax Number:

413-782-3050

Provider First Line Business Practice Location Address:

1268 SUMNER AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SPRINGFIELD

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01118-1770

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

413-782-5339

Provider Business Practice Location Address Fax Number:

413-782-3050

Provider Enumeration Date:

05/31/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  2075 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2204082 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 762249 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 207500 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: W15240 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 1207562002 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 5098016 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0309001 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 604061 . This is a "US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 988410 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: T59001 . This is a "PIONEER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 0012291 . This is a "NIEGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 11873 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".