Healthcare Provider Details

I. General information

NPI: 1376591404
Provider Name (Legal Business Name): ROBERT S DONOVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 INGOT DR
BLANDON PA
19510-9639
US

IV. Provider business mailing address

1 BALTHASER RD
SINKING SPRING PA
19608-9333
US

V. Phone/Fax

Practice location:
  • Phone: 610-944-8818
  • Fax: 610-944-7329
Mailing address:
  • Phone: 610-678-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD006775E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: