1902804503 NPI number — DR. LAURENCE DONAHUE M.D.

Table of content: DR. LAURENCE DONAHUE M.D. (NPI 1902804503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902804503 NPI number — DR. LAURENCE DONAHUE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONAHUE
Provider First Name:
LAURENCE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1902804503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8000
Provider Second Line Business Mailing Address:
DEPT. 441
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14267-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-844-5600
Provider Business Mailing Address Fax Number:
716-844-5750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 SENATOR KEATING BLVD
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14618-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-232-2980
Provider Business Practice Location Address Fax Number:
585-232-6522
Provider Enumeration Date:
07/08/2005

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: 208800000X , with the licence number:  169849 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40426004623 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 912152001 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1131039 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 912152001 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 26643801 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MD475H . This is a "PREFERED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1990343 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1099197 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3400004752 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 364974 . This is a "WELL CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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