Healthcare Provider Details

I. General information

NPI: 1033455522
Provider Name (Legal Business Name): ELIZABETH A DONAHOO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 FALLS RD SUITE 200
LUTHERVILLE MD
21093-4591
US

IV. Provider business mailing address

10807 FALLS RD SUITE 200
LUTHERVILLE MD
21093-4591
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-9393
  • Fax: 410-825-4945
Mailing address:
  • Phone: 410-321-9393
  • Fax: 410-825-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0080671
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: