Healthcare Provider Details

I. General information

NPI: 1932116324
Provider Name (Legal Business Name): THOMAS DONOHUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST. SAINT RAPHAEL FACULTY PHYSICIANS
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

1450 CHAPEL ST.
NEW HAVEN CT
06511-4405
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3363
  • Fax: 203-789-4081
Mailing address:
  • Phone: 203-789-3363
  • Fax: 203-789-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number038118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: