Healthcare Provider Details

I. General information

NPI: 1730585886
Provider Name (Legal Business Name): DONNA PRATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1882 E 32ND ST
LORAIN OH
44055-1812
US

IV. Provider business mailing address

1882 E 32ND ST
LORAIN OH
44055-1812
US

V. Phone/Fax

Practice location:
  • Phone: 440-989-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.062113
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number35.062113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: