1669479481 NPI number — DR. ROBERT L DONLEY D.O.

Table of content: DR. ROBERT L DONLEY D.O. (NPI 1669479481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669479481 NPI number — DR. ROBERT L DONLEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONLEY
Provider First Name:
ROBERT
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1669479481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
JEANNETTE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15644-2538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-527-8060
Provider Business Mailing Address Fax Number:
724-522-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 LIGONIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATROBE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15650-1882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-539-8581
Provider Business Practice Location Address Fax Number:
724-539-1575
Provider Enumeration Date:
07/07/2005

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: 207V00000X , with the licence number:  OS009494L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0018045270004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 244687 . This is a "HEALTH AMERICA/HEALTH ASS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: H18757 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 479399 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 156549 . This is a "THREE RIVERS-MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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