Healthcare Provider Details

I. General information

NPI: 1902806946
Provider Name (Legal Business Name): CARMEL DONOVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 E 78TH ST
NEW YORK NY
10021-1810
US

IV. Provider business mailing address

52 E 78TH ST
NEW YORK NY
10021-1810
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-3111
  • Fax: 212-861-1796
Mailing address:
  • Phone: 212-772-3111
  • Fax: 212-861-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number109861
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: