Healthcare Provider Details

I. General information

NPI: 1225437528
Provider Name (Legal Business Name): DR. EOIN DONNELLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5939
US

IV. Provider business mailing address

2730 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5939
US

V. Phone/Fax

Practice location:
  • Phone: 337-988-1585
  • Fax: 337-981-4694
Mailing address:
  • Phone: 337-988-1585
  • Fax: 337-981-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number333043
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number333043
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: