Healthcare Provider Details

I. General information

NPI: 1316912413
Provider Name (Legal Business Name): RICHARD M. DONNINI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 YANKEE PARK PL STE A
CENTERVILLE OH
45458-1838
US

IV. Provider business mailing address

1550 YANKEE PARK PL STE A
CENTERVILLE OH
45458-1838
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-4949
  • Fax: 397-439-4948
Mailing address:
  • Phone: 937-439-4949
  • Fax: 397-439-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34.003971
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: