Healthcare Provider Details

I. General information

NPI: 1801997762
Provider Name (Legal Business Name): WILLIAM JOSEPH DONOVAN JR. R.O.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTH HUNTINGTON AVE
BOSTON MA
02130
US

IV. Provider business mailing address

312 WASHINGTON ST
SOMERVILLE MA
02143-3829
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax: 854-364-5191
Mailing address:
  • Phone: 617-232-9500
  • Fax: 854-364-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: