Healthcare Provider Details

I. General information

NPI: 1174702989
Provider Name (Legal Business Name): PETER A DONELAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E FLETCHER AVE SUITE 200
TAMPA FL
33613-4656
US

IV. Provider business mailing address

3000 E FLETCHER AVE SUITE 200
TAMPA FL
33613-4656
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-1229
  • Fax: 813-972-1889
Mailing address:
  • Phone: 813-972-1229
  • Fax: 813-972-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0035372
License Number StateFL

VIII. Authorized Official

Name: DR. PETER A DONELAN
Title or Position: OWNER
Credential: MD PA
Phone: 813-972-1229