1114112869 NPI number — MR. STEVEN MICHAEL DONOHOE IDC

Table of content: MR. STEVEN MICHAEL DONOHOE IDC (NPI 1114112869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114112869 NPI number — MR. STEVEN MICHAEL DONOHOE IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONOHOE
Provider First Name:
STEVEN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
IDC
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:
1114112869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 DOVE PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269-2417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-617-4478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HALYBURTON NAVAL HEALTH CLINIC
Provider Second Line Business Practice Location Address:
PSC BOX 8023
Provider Business Practice Location Address City Name:
CHERRY POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-466-6930
Provider Business Practice Location Address Fax Number:
252-466-6570
Provider Enumeration Date:
09/06/2007

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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