Healthcare Provider Details

I. General information

NPI: 1891873915
Provider Name (Legal Business Name): EDWARD FRANCIS DONOVAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 7014
CINCINNATI OH
45229-1315
US

IV. Provider business mailing address

3936 RED BUD AVE
CINCINNATI OH
45229-1315
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-0180
  • Fax: 513-636-0171
Mailing address:
  • Phone: 513-636-0180
  • Fax: 513-636-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number040890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: