MEDICARE: TERRY ANN DONOVAN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	203	NC
2	213ES0131X	Foot Surgery Podiatrist	203	NC
3	213ES0103X	Foot & Ankle Surgery Podiatrist	203	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	561696265	OTHER		COMMERCIAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295739019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY ANN DONOVAN DPM

Provider Business Mailing Address
First Line	:	PO BOX 268
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-0268
Country	:	US
Telephone Number	:	336-766-8400
Fax Number	:	336-766-8486

Provider Business Practice Location Address
First Line	:	6341 COOK AVE
Second Line	:	STE A
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9380
Country	:	US
Telephone Number	:	336-766-8400
Fax Number	:	336-766-8486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/01/2016

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Directions to “ TERRY ANN DONOVAN DPM” Practice Location

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